EP3692999A1 - Diagnostic et traitements personnalisés rapides de l'acné - Google Patents

Diagnostic et traitements personnalisés rapides de l'acné Download PDF

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EP3692999A1
EP3692999A1 EP19218444.8A EP19218444A EP3692999A1 EP 3692999 A1 EP3692999 A1 EP 3692999A1 EP 19218444 A EP19218444 A EP 19218444A EP 3692999 A1 EP3692999 A1 EP 3692999A1
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Prior art keywords
acnes
strains
seq
acne
locus
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German (de)
English (en)
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Huiying Li
Shuta Tomida
Robert L. Modlin
Jeffery F. Miller
Sorel T. Fitz-Gibbon
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University of California
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University of California
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    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
    • C12Q1/68—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids
    • C12Q1/6876—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes
    • C12Q1/6883—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/66—Microorganisms or materials therefrom
    • A61K35/74—Bacteria
    • A61K35/741—Probiotics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/66—Microorganisms or materials therefrom
    • A61K35/76—Viruses; Subviral particles; Bacteriophages
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/02—Bacterial antigens
    • A61K39/0208—Specific bacteria not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/02—Bacterial antigens
    • A61K39/05—Actinobacteria, e.g. Actinomyces, Streptomyces, Nocardia, Bifidobacterium, Gardnerella, Corynebacterium; Propionibacterium
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00—Drugs for dermatological disorders
    • A61P17/10—Anti-acne agents
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N7/00—Viruses; Bacteriophages; Compositions thereof; Preparation or purification thereof
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
    • C12Q1/68—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids
    • C12Q1/6876—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes
    • C12Q1/6888—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for detection or identification of organisms
    • C12Q1/689—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for detection or identification of organisms for bacteria
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
    • C12Q1/70—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving virus or bacteriophage
    • C12Q1/701—Specific hybridization probes
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N2795/00—Bacteriophages
    • C12N2795/00011—Details
    • C12N2795/00032—Use of virus as therapeutic agent, other than vaccine, e.g. as cytolytic agent
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
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    • C12Q2600/00—Oligonucleotides characterized by their use
    • C12Q2600/112—Disease subtyping, staging or classification
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
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    • C12Q2600/00—Oligonucleotides characterized by their use
    • C12Q2600/156—Polymorphic or mutational markers
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
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    • C12Q2600/00—Oligonucleotides characterized by their use
    • C12Q2600/16—Primer sets for multiplex assays

Definitions

  • Acne is a skin condition that causes pimples or "zits.” This includes whiteheads, blackheads, and red, inflamed patches of skin (such as cysts). Acne occurs when tiny pores on the surface of the skin become clogged. Each pore opens to a follicle. A follicle contains a hair and an oil gland. The oil released by the gland helps remove old skin cells and keeps your skin soft. When glands produce too much oil, the pores can become blocked. Dirt, bacteria, and cells build up. The blockage is called a plug or comedone. If the top of the plug is white, it is called a whitehead. If the top of the plug is dark, it is called a blackhead. If the plug breaks open, swelling and red bumps occur. Acne that is deep in your skin can cause hard, painful cysts. This is called cystic acne.
  • Acne is most common in teenagers, but anyone can get acne. 85% of teenagers have acne. Hormonal changes may cause the skin to be more oily. Acne tends to run in families. It may be triggered by hormonal changes related to puberty, menstrual periods, pregnancy, birth control pills, or stress; greasy or oily cosmetic and hair products; certain drugs (such as steroids, testosterone, estrogen, and phenytoin); or high levels of humidity and sweating.
  • acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection, reducing the inflammation or doing all four.
  • These types of acne treatments include over-the-counter topical treatments, antibiotics, oral contraceptives and cosmetic procedures.
  • Acne lotions may dry up the oil, kill bacteria and promote sloughing of dead skin cells.
  • Over-the-counter (OTC) lotions are generally mild and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or sulfur as their active ingredient.
  • OTC Over-the-counter
  • Antibiotics may cause side effects, such as an upset stomach, dizziness or skin discoloration.
  • Isotretinoin Amnesteem, Claravis, Sotret
  • isotretinoin has many side effects, such as dry skin, depression, severe stomach pain, and muscle/joint/back pain, and can cause birth defects in babies whose mothers use isotretinoin.
  • Oral contraceptives including a combination of norgestimate and ethinyl estradiol (Ortho Tri-Cyclen, Previfem, others), can improve acne in women.
  • oral contraceptives may cause other side effects, such as headaches, breast tenderness, nausea, and depression.
  • Chemical peels and microdermabrasion may be helpful in controlling acne.
  • These cosmetic procedures which have traditionally been used to lessen the appearance of fine lines, sun damage, and minor facial scars, are most effective when used in combination with other acne treatments. They may cause temporary, severe redness, scaling and blistering, and long-term discoloration of the skin.
  • the present invention is directed to methods of diagnosis and personalized treatment in patients afflicted with acne.
  • the invention provides a method for determining whether an individual possesses acne comprising: obtaining a skin sample from an individual; isolating bacterial DNA from said sample; amplifying 16S ribosomal DNA in said sample; sequencing said amplified DNA products; and typing the individual's DNA based on one or more of the ten major ribotypes (RTs) of P . acnes strains, RT1-RT10 (SEQ ID NOs 1-10), wherein said typing occurs by determining whether said individual possesses one or more of RT1-RT10 and wherein said individual is diagnosed as having acne if said individual possesses RT4, RT5, RT7, RT8, RT9, or RT10.
  • said individual may be diagnosed as having acne if said individual possesses RT4 (SEQ ID NO:4), RT5 (SEQ ID NO:5), or RT8 (SEQ ID NO:8).
  • the invention provides a method for diagnosing different types of acne comprising: obtaining a skin sample from a subject; isolating bacterial DNA from said sample; amplifying 16S ribosomal DNA in said sample; sequencing said amplified DNA products; and typing the subject's DNA based on one or more of the five major microbiome types of P. acnes strains, wherein said subject is diagnosed as having acne if said subject is typed to microbiome IV or V.
  • the invention provides a method for rapidly diagnosing acne comprising: obtaining a skin sample from a subject; isolating bacterial DNA from said sample; using one or more primer sets to amplify said DNA; and analyzing said amplified DNA for the presence of a sequence having at least 95% homology with at least one of SEQ ID NOs 29-32 and 82-434, wherein said subject is diagnosed as having acne if the presence of a sequence having at least 95% homology with at least one of SEQ ID NOs 29-32 and 82-434 exists.
  • said amplified DNA may be analyzed for the presence of a sequence having at least 99% homology with at least one of SEQ ID NOs 29-32 and 82-434 and wherein said subject is diagnosed as having acne if the presence of a sequence having at least 99% homology with at least one of SEQ ID NOs 29-32 and 82-434 exists.
  • said amplified DNA may be analyzed for the presence of at least one of SEQ ID NOs 29-32 and 82-434 and wherein said subject is diagnosed as having acne if the presence of at least one of SEQ ID NOs 29-32 and 82-434 exists.
  • the invention provides a method for rapidly diagnosing acne comprising: obtaining a skin sample from a subject; isolating bacterial DNA from said sample; using one or more primer sets to amplify said DNA; using one or more probes to detect said amplified DNA; and analyzing said probe signals for the presence of Locus 1 (at least one sequence having at least 95% homology to at least one of SEQ ID NOs 29 and 82-97), Locus 2 (at least one sequence having at least 95% homology to at least one of SEQ ID NOs 30 and 98-186), Locus 3 (at least one sequence having at least 95% homology to at least one of SEQ ID NOs 31 and 187-423), and/or Locus 4 (at least one sequence having at least 95% homology to at least one of SEQ ID NOs 32 and 424-434), wherein said subject is diagnosed as having acne if one or more of Loci 1-4 are present.
  • the signals may be analyzed for the presence of Locus 1, Locus 1, Locu
  • a primer of said primer sets may be selected from the group consisting of SEQ ID NOs 11, 12, 17, and 18 (for Locus 1), SEQ ID NOs 13, 14, 20, and 21 (for Locus 2), SEQ ID NOs 15, 16, 23, and 24 (for Locus 3), and SEQ ID NOs 26 and 27 (for Locus 4).
  • said probes may be SEQ ID NO:19 (for Locus 1), SEQ ID NO:22 (for Locus 2), SEQ ID NO:25 (for Locus 3), and SEQ ID NO:28 (for Locus 4).
  • the invention provides a vaccine for the prevention and/or treatment of acne caused by P. acnes comprising a heat inactivated P. acnes strain, an attenuated protein of said strain, or combination thereof, wherein said strain is an RT4 strain, an RT5 strain, an RT7 strain, an RT8 strain, an RT9 strain, or an RT10 strain.
  • the invention provides a vaccine for the prevention and/or treatment of acne caused by P. acnes comprising a heat inactivated P. acnes strain, an attenuated protein of said strain, or combination thereof identified to be specific to a subject based on 16S rDNA sequence analysis of the strains of P . acnes affecting said subject.
  • said heat inactivated P . acnes strain, attenuated protein, or combination thereof may be specific for at least one of unique genomic loci, regions, or sequences identified for the strains of P. acnes.
  • Said heat inactivated P. acnes strain, attenuated protein, or combination thereof may be specific for at least one of Locus 1 (SEQ ID NOs 29 and 82-97), Locus 2 (SEQ ID NOs 30 and 98-186), Locus 3 (31 and 187-423), and Locus 4 (32 and 424-434).
  • the invention provides a method for the personalized treatment of acne comprising determining the strains of P. acnes affecting a subject and treating said subject with an active ingredient directed to at least one detected strain of P . acnes, wherein the active ingredient comprises a drug targeting specific strains of P. acnes, wherein the targeting drug comprises small molecules, antisense molecules, siRNA, biologics, antibodies, and combinations thereof targeting genomic elements specific for strains of P. acnes associated with acne.
  • the invention provides a method for treating acne comprising: administering an effective amount of a probiotic that comprises at least one strain of P . acnes that is associated with healthy or normal skin based on its 16S rDNA.
  • Said strain may be an RT6 strain.
  • Said strain may have at least 95% homology to SEQ ID NO:51, SEQ ID NO:52, SEQ ID NO:53, or SEQ ID NO:54, such as at least 99% homology or 100% homology.
  • the invention provides a method for treating acne comprising: administering an effective amount of a metabolite produced by a strain of P. acnes that is associated with healthy or normal skin, wherein said metabolite is selected from the group comprising bacterial culture supernatant, cell lysate, proteins, nucleic acids, lipids, and other bacterial molecules.
  • Said strain may be an RT6 strain.
  • Said strain may have at least 95% homology to SEQ ID NO:51, SEQ ID NO:52, SEQ ID NO:53, or SEQ ID NO:54, such as at least 99% homology or 100% homology.
  • the invention provides a method for treating acne in a subject comprising: administering an effective amount of a drug specifically targeting RT4, RT5, RT7, RT8, RT9, or RT10, when said subject is determined to possess RT4, RT5, RT7, RT8, RT9, or RT10, respectively.
  • a drug specifically targeting RT4, RT5, RT7, RT8, RT9, or RT10, when said subject is determined to possess RT4, RT5, RT7, RT8, RT9, or RT10, respectively.
  • Said drug may be a small molecule, antisense molecule, siRNA, biologic, antibody, or combination thereof.
  • the invention provides a composition comprising at least one strain of P. acnes that is associated with healthy or normal skin.
  • Said strain may be an RT6 strain.
  • Said strain may have at least 95% homology to SEQ ID NO:51, SEQ ID NO:52, SEQ ID NO:53, or SEQ ID NO:54, such as at least 99% homology or 100% homology.
  • the invention provides a method for diagnosing IB-3-based acne comprising: obtaining a skin sample from a subject; isolating bacterial DNA from said sample; using one or more primer sets to amplify said DNA; and analyzing said amplified DNA for the presence of a sequence having at least 95% homology with at least one of SEQ ID NOs 55-81, wherein said subject is diagnosed as having IB-3-based acne if the presence of a sequence having at least 95% homology with at least one of SEQ ID NOs 55-81 exists.
  • the invention provides a method for the personalized treatment of acne comprising determining the strain(s) of acne affecting a subject and administering to said subject an effective amount of at least one phage specifically directed to said strain(s).
  • the subject may be treated with phage directed against an RT4 strain, an RT5 strain, an RT7 strain, and RT8 strain, an RT9 strain, and/or an RT10 strain.
  • the invention provides a method for treating an individual suffering from acne of microbiome type I comprising administering to said individual an effective amount of a phage, wherein said phage is selected from the group consisting of: PHL113M01 (SEQ ID NO:36), PHL111M01 (SEQ ID NO:33), PHL082M00 (SEQ ID NO:47), PHL060L00 (SEQ ID NO:34), PHL067M10 (SEQ ID NO:42), PHL071N05 (SEQ ID NO:41), PHL112N00 (SEQ ID NO:35), PHL037M02 (SEQ ID NO:40), PHL085N00 (SEQ ID NO:46), PHL115M02 (SEQ ID NO:43), PHL085M01 (SEQ ID NO:44), PHL114L00 (SEQ ID NO:37), PHL010M04 (SEQ ID NO:38), and PHL066M04 (SEQ ID NO:39).
  • PHL113M01 SEQ ID
  • the invention provides a method for treating an individual suffering from acne of microbiome type I with IB-3 strain comprising administering to said individual an effective amount of a phage, wherein said phage is selected from the group consisting of: PHL082M00 (SEQ ID NO:47) and PHL071 N05 (SEQ ID NO:41).
  • the invention provides a method for treating an individual suffering from acne of microbiome type II comprising administering to said individual an effective amount of a phage, wherein said phage is selected from the group consisting of: PHL113M01 (SEQ ID NO:36), PHL060L00 (SEQ ID NO:34), PHL112N00 (SEQ ID NO:35), and PHL085M01 (SEQ ID NO:44).
  • the invention provides a method for treating an individual suffering from acne of microbiome type III or dominant RT8 comprising administering to said individual an effective amount of a phage, wherein said phage is selected from the group consisting of: PHL113M01 (SEQ ID NO:36), PHL111M01 (SEQ ID NO:33), PHL082M00 (SEQ ID NO:47), PHL060L00 (SEQ ID NO:34), PHL067M10 (SEQ ID NO:42), PHL071N05 (SEQ ID NO:41), PHL112N00 (SEQ ID NO:35), PHL037M02 (SEQ ID NO:45), PHL085N00 (SEQ ID NO:46), PHL115M02 (SEQ ID NO:43), PHL085M01 (SEQ ID NO:44), PHL114L00 (SEQ ID NO:37), PHL073M02 (SEQ ID NO:40), PHL010M04 (SEQ ID NO:38), and P
  • the invention provides a method for treating an individual suffering from acne of microbiome type IV comprising administering to said individual an effective amount of a phage, wherein said phage is selected from the group consisting of: PHL113M01 (SEQ ID NO:36), PHL111M01 (SEQ ID NO:33), PHL082M00 (SEQ ID NO:47), PHL060L00 (SEQ ID NO:34), PHL067M10 (SEQ ID NO:42), PHL071N05 (SEQ ID NO:41), PHL112N00 (SEQ ID NO:35), PHL037M02 (SEQ ID NO:45), PHL085N00 (SEQ ID NO:46), PHL115M02 (SEQ ID NO:43), PHL085M01 (SEQ ID NO:44), PHL114L00 (SEQ ID NO:37), PHL073M02 (SEQ ID NO:40), PHL010M04 (SEQ ID NO:38), and PHL066M04
  • the invention provides a method for treating an individual suffering from acne of microbiome type V comprising administering to said individual an effective amount of a phage, wherein said phage is selected from the group consisting of: PHL113M01 (SEQ ID NO:36), PHL111M01 (SEQ ID NO:33), PHL082M00 (SEQ ID NO:47), PHL060L00 (SEQ ID NO:34), PHL067M10 (SEQ ID NO:42), PHL071N05 (SEQ ID NO:41), PHL112N00 (SEQ ID NO:35), PHL037M02 (SEQ ID NO:45), PHL085N00 (SEQ ID NO:46), PHL115M02 (SEQ ID NO:43), PHL085M01 (SEQ ID NO:44), PHL114L00 (SEQ ID NO:37), PHL073M02 (SEQ ID NO:40), PHL010M04 (SEQ ID NO:38), and PHL066M04
  • the invention provides a method for treating a Propionibacterium humerusii-associated malady comprising administering to said individual an effective amount of a phage, wherein said phage is selected from the group consisting of: PHL113M01 (SEQ ID NO:36), PHL111M01 (SEQ ID NO:33), PHL082M00 (SEQ ID NO:47), PHL067M10 (SEQ ID NO:42), PHL071N05 (SEQ ID NO:41), PHL085N00 (SEQ ID NO:46), PHL085M01 (SEQ ID NO:44), PHL114L00 (SEQ ID NO:37), PHL073M02 (SEQ ID NO:40), and PHL010M04 (SEQ ID NO:38).
  • PHL113M01 SEQ ID NO:36
  • PHL111M01 SEQ ID NO:33
  • PHL082M00 SEQ ID NO:47
  • PHL067M10 SEQ ID NO:42
  • the invention provides a kit for diagnosing acne in a subject, wherein said kit comprises: at least one primer selected from the group comprising SEQ ID NOs 11-18, 20, 21, 23, 24, 26, and 27; and instructions for use.
  • the invention provides a kit for diagnosing acne in a subject, wherein said kit comprises: at least one primer selected from the group comprising SEQ ID NOs 11-18, 20, 21, 23, 24, 26, and 27; at least one probe selected from the group comprising SEQ ID NOs 19, 22, 25, and 28; and instructions for use.
  • the invention provides a method for determining whether an individual possesses acne comprising: obtaining a skin sample from an individual; isolating bacterial DNA from said sample; amplifying 16S ribosomal DNA in said sample; sequencing said amplified DNA products; and typing the individual's DNA based on one or more of the ten major ribotypes (RTs) of P. acnes strains, RT1-RT10 (SEQ ID NOs 1-10), wherein said typing occurs by determining whether said individual possesses one or more of RT1-RT10 and wherein said individual is diagnosed as having acne if said individual possesses RT4, RT5, RT7, RT8, RT9, or RT10.
  • said individual may be diagnosed as having acne if said individual possesses RT4 (SEQ ID NO:4), RT5 (SEQ ID NO:5), or RT8 (SEQ ID NO:8).
  • the invention provides a method for diagnosing different types of acne comprising: obtaining a skin sample from a subject; isolating bacterial DNA from said sample; amplifying 16S ribosomal DNA in said sample; sequencing said amplified DNA products; and typing the subject's DNA based on one or more of the five major microbiome types of P. acnes strains, wherein said subject is diagnosed as having acne if said subject is typed to microbiome IV or V.
  • the invention provides a method for rapidly diagnosing acne comprising: obtaining a skin sample from a subject; isolating bacterial DNA from said sample; using one or more primer sets to amplify said DNA; and analyzing said amplified DNA for the presence of a sequence having at least 95% homology with at least one of SEQ ID NOs 29-32 and 82-434, wherein said subject is diagnosed as having acne if the presence of a sequence having at least 95% homology with at least one of SEQ ID NOs 29-32 and 82-434 exists.
  • said amplified DNA may be analyzed for the presence of a sequence having at least 99% homology with at least one of SEQ ID NOs 29-32 and 82-434 and wherein said subject is diagnosed as having acne if the presence of a sequence having at least 99% homology with at least one of SEQ ID NOs 29-32 and 82-434 exists.
  • said amplified DNA may be analyzed for the presence of at least one of SEQ ID NOs 29-32 and 82-434 and wherein said subject is diagnosed as having acne if the presence of at least one of SEQ ID NOs 29-32 and 82-434 exists.
  • the invention provides a method for rapidly diagnosing acne comprising: obtaining a skin sample from a subject; isolating bacterial DNA from said sample; using one or more primer sets to amplify said DNA; using one or more probes to detect said amplified DNA; and analyzing said probe signals for the presence of Locus 1 (at least one sequence having at least 95% homology to at least one of SEQ ID NOs 29 and 82-97), Locus 2 (at least one sequence having at least 95% homology to at least one of SEQ ID NOs 30 and 98-186), Locus 3 (at least one sequence having at least 95% homology to at least one of SEQ ID NOs 31 and 187-423), and/or Locus 4 (at least one sequence having at least 95% homology to at least one of SEQ ID NOs 32 and 424-434), wherein said subject is diagnosed as having acne if one or more of Loci 1-4 are present.
  • the signals may be analyzed for the presence of Locus 1, Locus 1, Locu
  • a primer of said primer sets may be selected from the group consisting of SEQ ID NOs 11, 12, 17, and 18 (for Locus 1), SEQ ID NOs 13, 14, 20, and 21 (for Locus 2), SEQ ID NOs 15, 16, 23, and 24 (for Locus 3), and SEQ ID NOs 26 and 27 (for Locus 4).
  • said probes may be SEQ ID NO: 19 (for Locus 1), SEQ ID NO:22 (for Locus 2), SEQ ID NO:25 (for Locus 3), and SEQ ID NO:28 (for Locus 4).
  • the invention provides a vaccine for the prevention and/or treatment of acne caused by P. acnes comprising a heat inactivated P. acnes strain, an attenuated protein of said strain, or combination thereof, wherein said strain is an RT4 strain, an RT5 strain, an RT7 strain, an RT8 strain, an RT9 strain, or an RT10 strain.
  • the invention provides a vaccine for the prevention and/or treatment of acne caused by P. acnes comprising a heat inactivated P. acnes strain, an attenuated protein of said strain, or combination thereof identified to be specific to a subject based on 16S rDNA sequence analysis of the strains of P. acnes affecting said subject.
  • said heat inactivated P. acnes strain, attenuated protein, or combination thereof may be specific for at least one of unique genomic loci, regions, or sequences identified for the strains of P. acnes.
  • Said heat inactivated P. acnes strain, attenuated protein, or combination thereof may be specific for at least one of Locus 1 (SEQ ID NOs 29 and 82-97), Locus 2 (SEQ ID NOs 30 and 98-186), Locus 3 (31 and 187-423), and Locus 4 (32 and 424-434).
  • the invention provides a method for the personalized treatment of acne comprising determining the strains of P. acnes affecting a subject and treating said subject with an active ingredient directed to at least one detected strain of P. acnes, wherein the active ingredient comprises a drug targeting specific strains of P. acnes, wherein the targeting drug comprises small molecules, antisense molecules, siRNA, biologics, antibodies, and combinations thereof targeting genomic elements specific for strains of P. acnes associated with acne.
  • the invention provides a method for treating acne comprising: administering an effective amount of a probiotic that comprises at least one strain of P. acnes that is associated with healthy or normal skin based on its 16S rDNA.
  • Said strain may be an RT6 strain.
  • Said strain may have at least 95% homology to SEQ ID NO:51, SEQ ID NO:52, SEQ ID NO:53, or SEQ ID NO:54, such as at least 99% homology or 100% homology.
  • the invention provides a method for treating acne comprising: administering an effective amount of a metabolite produced by a strain of P. acnes that is associated with healthy or normal skin, wherein said metabolite is selected from the group comprising bacterial culture supernatant, cell lysate, proteins, nucleic acids, lipids, and other bacterial molecules.
  • Said strain may be an RT6 strain.
  • Said strain may have at least 95% homology to SEQ ID NO:51, SEQ ID NO:52, SEQ ID NO:53, or SEQ ID NO:54, such as at least 99% homology or 100% homology.
  • the invention provides a method for treating acne in a subject comprising: administering an effective amount of a drug specifically targeting RT4, RT5, RT7, RT8, RT9, or RT10, when said subject is determined to possess RT4, RT5, RT7, RT8, RT9, or RT10, respectively.
  • a drug specifically targeting RT4, RT5, RT7, RT8, RT9, or RT10, when said subject is determined to possess RT4, RT5, RT7, RT8, RT9, or RT10, respectively.
  • Said drug may be a small molecule, antisense molecule, siRNA, biologic, antibody, or combination thereof.
  • the invention provides a composition comprising at least one strain of P. acnes that is associated with healthy or normal skin.
  • Said strain may be an RT6 strain.
  • Said strain may have at least 95% homology to SEQ ID NO:51, SEQ ID NO:52, SEQ ID NO:53, or SEQ ID NO:54, such as at least 99% homology or 100% homology.
  • the invention provides a method for diagnosing IB-3-based acne comprising: obtaining a skin sample from a subject; isolating bacterial DNA from said sample; using one or more primer sets to amplify said DNA; and analyzing said amplified DNA for the presence of a sequence having at least 95% homology with at least one of SEQ ID NOs 55-81, wherein said subject is diagnosed as having IB-3-based acne if the presence of a sequence having at least 95% homology with at least one of SEQ ID NOs 55-81 exists.
  • the invention provides a method for the personalized treatment of acne comprising determining the strain(s) of acne affecting a subject and administering to said subject an effective amount of at least one phage specifically directed to said strain(s).
  • the subject may be treated with phage directed against an RT4 strain, an RT5 strain, an RT7 strain, and RT8 strain, an RT9 strain, and/or an RT10 strain.
  • the invention provides a method for treating an individual suffering from acne of microbiome type I comprising administering to said individual an effective amount of a phage, wherein said phage is selected from the group consisting of: PHL113M01 (SEQ ID NO:36), PHL111M01 (SEQ ID NO:33), PHL082M00 (SEQ ID NO:47), PHL060L00 (SEQ ID NO:34), PHL067M10 (SEQ ID NO:42), PHL071N05 (SEQ ID NO:41), PHL112N00 (SEQ ID NO:35), PHL037M02 (SEQ ID NO:40), PHL085N00 (SEQ ID NO:46), PHL115M02 (SEQ ID NO:43), PHL085M01 (SEQ ID NO:44), PHL114L00 (SEQ ID NO:37), PHL010M04 (SEQ ID NO:38), and PHL066M04 (SEQ ID NO:39).
  • PHL113M01 SEQ ID
  • the invention provides a method for treating an individual suffering from acne of microbiome type I with IB-3 strain comprising administering to said individual an effective amount of a phage, wherein said phage is selected from the group consisting of: PHL082M00 (SEQ ID NO:47) and PHL071N05 (SEQ ID NO:41).
  • the invention provides a method for treating an individual suffering from acne of microbiome type II comprising administering to said individual an effective amount of a phage, wherein said phage is selected from the group consisting of: PHL113M01 (SEQ ID NO:36), PHL060L00 (SEQ ID NO:34), PHL112N00 (SEQ ID NO:35), and PHL085M01 (SEQ ID NO:44).
  • the invention provides a method for treating an individual suffering from acne of microbiome type III or dominant RT8 comprising administering to said individual an effective amount of a phage, wherein said phage is selected from the group consisting of: PHL113M01 (SEQ ID NO:36), PHL111M01 (SEQ ID NO:33), PHL082M00 (SEQ ID NO:47), PHL060L00 (SEQ ID NO:34), PHL067M10 (SEQ ID NO:42), PHL071N05 (SEQ ID NO:41), PHL112N00 (SEQ ID NO:35), PHL037M02 (SEQ ID NO:45), PHL085N00 (SEQ ID NO:46), PHL115M02 (SEQ ID NO:43), PHL085M01 (SEQ ID NO:44), PHL114L00 (SEQ ID NO:37), PHL073M02 (SEQ ID NO:40), PHL010M04 (SEQ ID NO:38), and P
  • the invention provides a method for treating an individual suffering from acne of microbiome type IV comprising administering to said individual an effective amount of a phage, wherein said phage is selected from the group consisting of: PHL113M01 (SEQ ID NO:36), PHL111M01 (SEQ ID NO:33), PHL082M00 (SEQ ID NO:47), PHL060L00 (SEQ ID NO:34), PHL067M10 (SEQ ID NO:42), PHL071N05 (SEQ ID NO:41), PHL112N00 (SEQ ID NO:35), PHL037M02 (SEQ ID NO:45), PHL085N00 (SEQ ID NO:46), PHL115M02 (SEQ ID NO:43), PHL085M01 (SEQ ID NO:44), PHL114L00 (SEQ ID NO:37), PHL073M02 (SEQ ID NO:40), PHL010M04 (SEQ ID NO:38), and PHL066M04
  • the invention provides a method for treating an individual suffering from acne of microbiome type V comprising administering to said individual an effective amount of a phage, wherein said phage is selected from the group consisting of: PHL113M01 (SEQ ID NO:36), PHL111M01 (SEQ ID NO:33), PHL082M00 (SEQ ID NO:47), PHL060L00 (SEQ ID NO:34), PHL067M10 (SEQ ID NO:42), PHL071N05 (SEQ ID NO:41), PHL112N00 (SEQ ID NO:35), PHL037M02 (SEQ ID NO:45), PHL085N00 (SEQ ID NO:46), PHL115M02 (SEQ ID NO:43), PHL085M01 (SEQ ID NO:44), PHL114L00 (SEQ ID NO:37), PHL073M02 (SEQ ID NO:40), PHL010M04 (SEQ ID NO:38), and PHL066M04
  • the invention provides a method for treating a Propionibacterium humerusii-associated malady comprising administering to said individual an effective amount of a phage, wherein said phage is selected from the group consisting of: PHL113M01 (SEQ ID NO:36), PHL111M01 (SEQ ID NO:33), PHL082M00 (SEQ ID NO:47), PHL067M10 (SEQ ID NO:42), PHL071N05 (SEQ ID NO:41), PHL085N00 (SEQ ID NO:46), PHL085M01 (SEQ ID NO:44), PHL114L00 (SEQ ID NO:37), PHL073M02 (SEQ ID NO:40), and PHL010M04 (SEQ ID NO:38).
  • PHL113M01 SEQ ID NO:36
  • PHL111M01 SEQ ID NO:33
  • PHL082M00 SEQ ID NO:47
  • PHL067M10 SEQ ID NO:42
  • the invention provides a kit for diagnosing acne in a subject, wherein said kit comprises: at least one primer selected from the group comprising SEQ ID NOs 11-18, 20, 21, 23, 24, 26, and 27; and instructions for use.
  • the invention provides a kit for diagnosing acne in a subject, wherein said kit comprises: at least one primer selected from the group comprising SEQ ID NOs 11-18, 20, 21, 23, 24, 26, and 27; at least one probe selected from the group comprising SEQ ID NOs 19, 22, 25, and 28; and instructions for use.
  • Nucleotide, polynucleotide, or nucleic acid sequence will be understood to mean both a double-stranded or single-stranded DNA in the monomeric and dimeric forms and the transcription products of said DNAs.
  • Homologous nucleotide sequence means a nucleotide sequence having at least a percentage identity with the bases of a nucleotide sequence according to the invention of at least 80%, preferably 90%, 95%, 96%, 97%, 98%, 99% or 100%. This percentage is statistical and the differences between two nucleotide sequences may be determined at random or over the whole of their length.
  • the invention comprises the polypeptides encoded by a nucleotide sequence according to the invention, including a polypeptide whose sequence is represented by a fragment.
  • polypeptide encoded by a nucleotide sequence according to the invention, including a polypeptide whose sequence is represented by a fragment.
  • Polypeptides allow monoclonal or polyclonal antibodies to be prepared which are characterized in that they specifically recognize the polypeptides.
  • the invention relates to mono- or polyclonal antibodies or their fragments, or chimeric antibodies, characterized in that they are capable of specifically recognizing a polypeptide.
  • Polypeptides used in vaccine compositions according to the invention may be selected by techniques known to the person skilled in the art such as, for example, depending on the capacity of said polypeptides to stimulate the T cells, which is translated, for example, by their proliferation or the secretion of interleukins, and which leads to the production of antibodies directed against said polypeptides.
  • Vaccine combinations will preferably be combined with a pharmaceutically acceptable vehicle and, if need be, with one or more adjuvants of the appropriate immunity.
  • Pharmaceutically acceptable vehicle means a compound or a combination of compounds that does not provoke secondary reactions and which allows, for example, the facilitation of the administration of the active compound, an increase in its duration of life and/or its efficacy in the body, an increase in its solubility in solution, or an improvement in its conservation.
  • Some of the P. acnes lineages and microbiome types are highly enriched in acne patients and some are associated with healthy skin.
  • the unique genomic components of each major lineage including a linear plasmid that is unique to acne-associated lineages, have been identified. This information is used to, for example: (1) for a method/kit to isolate bacterial DNA/RNA from pilosebaceous units for downstream analysis: (2) rapidly and accurately detect/diagnose/identify the microbiome type of the affected subject and the major strains of P. acnes present in the pores of the affected subject; (3) develop vaccines against acne-associated P.
  • acnes strains (4) develop probiotics using the strains associated with healthy skin in topical creams, solutions, and the like; (5) develop drugs, including small molecules, biologics, and antibodies targeting the genetic elements and biological pathways unique to the P. acnes strains associated with acne, and (6) to develop bacteriophage-based strain specific therapy to treat acne.
  • microbiome type of a subject affected with acne is diagnosed, several approaches described below may be used formulate an effective treatment plan, For example, if the subjects have microbiome types IV or V, or are dominated by P. acnes RT10 strains, it is less likely that antibiotic treatment will succeed because these strains are antibiotic resistant. However, other method treatments remain available, such as retinoids.
  • target specific drugs including small molecules, biologics, and antibodies may be more effective treatments.
  • such a patient may be treated with antibodies targeting the genetic elements and biological pathways that are unique to P. acnes strains associated with acne.
  • the additional treatment of phage therapy may be more effective.
  • the present invention also pertains to alternative treatment strategies for acne treatment to balance the relative abundance of P. acnes strains by promoting the growth of health-associated strains.
  • the present invention pertains to methods and kits to isolate bacterial DNA/RNA from pores of affected subjects for downstream genetic analysis. More specifically, the present invention pertains to protocols for the extraction of bacterial genomic DNA and RNA from microcomedone spamples.
  • Biore® Deep Cleansing Pore Strips may be used to sampl the bacteria from a subject.
  • Genomic DNA may be extracted according to methods known in the art.
  • the QIAamp DNA Micro Kit (Qiagen) is a commercially available kit that may be used to extract genomic DNA from the supernatant obtained by lysing cells/microcomedones using a beadbeater.
  • the present invention also pertains to fast and accurate methods and kits for the detection and/or diagnosis of microbiome types in affected subjects.
  • the microbiome typing/microbiome-specific treatment is based on ten major lineages of P. acnes strains and five major microbiome types in the human pilosebaceous unit found through a comprehensive metagenomic analysis using full length 16S rDNA sequencing.
  • samples were PCR-amplified using 16S rDNA specific primers with the following sequences: 27f-MP 5'AGRGTTTGATCMTGGCTCAG-3' and 1492r-MP 5'-TACGGYTACCTTGTTAYGACTT-3'.
  • the 1.4 Kb product is excised and further purified using, for example, a Quigen QIAquick Gel Extraction Kit.
  • the purified product is cloned into OneShot E coli. cells using, for example, a TOPO TA cloning kit from Invitrogen.
  • Sequencing is done with a universal forward, universal reverse, and for a subset, internal 16S rDNA primer 907R with sequences of TGTAAAACGACGGCCAGT (forward), CAGGAAACAGCTATGACC (reverse), and CCGTCAATTCCTTTRAGTTT (907R). Sequence reactions were loaded on ABI 3730 machines from ABI on 50 cm arrays with a long read run module.
  • Each lineage of P. acnes has unique genomic loci, regions, and sequences. Accordingly, specific primers may be generated to target the lineage-specific genomic regions to detect the presence or absence of each lineage, as well as the relative amount of each lineage using methods known in the art, such as PCR/qPCR. This occurs within several hours of obtaining the samples. Prior to Applicants' invention, this required much more time - often weeks using culture-based methods. According to one embodiment of the invention, affected subjects are grouped for microbiome specific treatments based on these diagnoses.
  • unique genomic loci 1, 2, and 3 for strains of ribotypes 4 and 5 have been shown to be associated with acne.
  • lineages that contain these loci can be distinguished from lineages that lack these loci.
  • the relative abundance of each strain may also be detected.
  • Analysis of a mock community has shown that isolates with loci 1, 2 and 3 in an abundance of 7.5% or higher in the microbiome may be detected using these techniques. Given the sensitivity of qPCR, lower abundance levels to a few DNA copies may also be detectable.
  • vaccines are developed against acne-associated P. acnes strains.
  • personalized vaccines are developed against acne-associated P. acnes strains.
  • vaccines are developed against acne-associated P. acnes strains using inactive P. acnes strains or heat attenuated proteins. Strains suitable for use as vaccines may be identified based on 16S rDNA sequencing, indentifying lineages of P. acnes strains associated with acne, and the unique genomic loci, regions, and sequences for each lineage to specifically target strains of P. acnes associated with acne and not those strains associated with healthy skin.
  • loci 1, 2, and 3 may be targets for vaccination because these loci are unique to ribotypes 4 and 5, and are not found in commensal strains.
  • Locus 4, which is unique to ribotype 8 may also serve as a potential target for vaccine therapy.
  • Table 2 The list of genes encoded in loci 1, 2, 3, and 4 are shown in Table 2.
  • the present invention also pertains to probiotics developed using P. acnes strains associated with healthy skin in medicines, compositions, topical creams, solutions, or other cosmetic products.
  • Probiotics have, in the past, been used in topical creams.
  • PROBIOTIC LABTM announced that mixture of 14 specific strains of bacteria was used for treatment of cystic acne (http://www.probiotic-lab.com/aboutusprobioticlab.html).
  • Probiotic skin care/DERMBIOTIX has a product line - Probiotic Collagen Complex (PC3), which is claimed to have targeted anti-aging benefits to the skin. However, this is not targeted to acne treatment.
  • PC3 Probiotic Collagen Complex
  • Probiotic Collagen Complex infuses the skin with the positive bacteria required to effectively combat and eradicate excess negative bacteria caused by external factors (http://www.dermbiotix.com).
  • PC3 Probiotic Collagen Complex
  • skin probiotics are developed for acne treatment using P. acnes strains associated with healthy/normal skin.
  • skin probiotics are developed for acne treatment using P. acnes strains associated with healthy/normal skin based on the 16S rDNA sequencing.
  • the RT6 lineage of P. acnes and associated with healthy skin is used as a topical product.
  • the RT6 lineage of P. acnes is used by inoculating this isolate on the human skin in order to compete off the acne associated strains.
  • molecules, including proteins, nucleic acids, lipids, and other metabolites, supernatant of cultures, and/or cell lysate of these strains may be used at probiotics.
  • the present invention also pertains to drugs targeting acne associated P. acnes strains. This is based upon multiple genome comparison of P. acnes in combination with 16S rDNA metagenomic analysis, thereby identifying certain strains and genomic variations associated with acne.
  • Drugs intended to target acne associated P. acnes include custom designed small molecules, antisense molecules, siRNA molecules, biologics, and antibodies targeting genomic elements specific for strains which are associated with acne.
  • Antisense RNA, antibodies, or small molecules can be designed targeting loci 1, 2, 3, and 4. Strains with ribotypes 4, 5, and 10 are antibiotic resistant. Thus, there is a need in the art for new antibiotics targeting ribotypes 4, 5, and 10.
  • the present invention also pertains to personalized phage therapy for subjects affected with acne comprising phages specific to certain strains of P. acnes.
  • P. acnes is commensal and some strains play a protective role for hosts.
  • personalized phage therapies include a selections of phages targeting P. acnes strains that have been shown to lack a protective role for subjects affected by acne.
  • personalized phage therapy may be developed according to their bacterial host specificity of the phages to target specific strains of P. acnes, leaving health associated strains intact.
  • P. acnes lineages RT2 and RT6 have a CRISPR/Cas structure, indicating they have resistance against certain phage infection and plasmid conjugation.
  • Table 5 shows the sensitivity and resistance of specific P. acnes strains to specific P . acnes phages.
  • the human skin microbiome plays important roles in skin health and disease.
  • the bacterial population structure and diversity at the strain level was poorly understood.
  • the inventors compared the skin microbiome at the strain level and genome level of Propionibacterium acnes, a dominant skin commensal, between 49 acne patients and 52 healthy individuals by sampling the pilosebaceous units on their noses. Metagenomic analysis demonstrated that while the relative abundances of P. acnes were similar, the strain population structures were significantly different in the two cohorts. Certain strains were highly associated with acne and other strains were enriched in healthy skin.
  • sequencing 66 novel P. acnes strains and comparing 71 P. acnes genomes the inventors identified potential genetic determinants of various P.
  • acnes strains in association with acne or health.
  • the analysis indicates that acquired DNA sequences and bacterial immune elements may play roles in determining virulence properties of P. acnes strains and some may be targets for therapeutic interventions.
  • This study demonstrates a previously-unreported paradigm of commensal strain populations that explains the pathogenesis of human diseases. It underscores the importance of strain level analysis of the human microbiome to define the role of commensals in health and disease.
  • MRSA methicillin-resistant Staphylococcus aureus
  • Escherichia coli O157 Chose-Topping et al., 2008; Tarr et al., 2005.
  • Acne vulgaris commonly called acne
  • acne is one of the most common skin diseases with a prevalence of up to 85% of teenagers and 11% of adults (White, 1998).
  • P . acnes protects the human skin as a commensal bacterium or functions as a pathogenic factor in acne, or both, remained to be elucidated.
  • Applicants compared the skin microbiome at the strain level and genome level in 49 acne patients and 52 normal individuals using a combination of metagenomics and genome sequencing.
  • 16S ribosomal DNA rDNA
  • rDNA 16S ribosomal DNA
  • the population structure of P. acnes strains was determined in each sample.
  • each P. acnes strain was assigned an "acne index" by calculating its prevalence in acne patients based on the 16S rDNA metagenomic data.
  • the P. acnes strains associated with the acne patient group were identified, as well as the strains enriched in the individuals with normal skin.
  • positions 27 to 1492 were PCR amplified. Yet, when analyzing the sequence only positions 29-1483 are studied. The numbering of positions is based on the E. coli system of nomenclature. Thus, the sequences between 29-1483 are important for determining the ribotype (there are many ribotypes, not just 10). As for the top 10 ribotypes, sequences between positions 529-1336 of the 16A rRNA are sufficient.
  • each unique 16S rDNA sequence as a 16S rDNA allele type is called a ribotype (RT).
  • RT1 ribotype 1
  • All other defined ribotypes have 99% or greater sequence identity to RT1. Similar to the distributions seen at higher taxonomical levels (Bik et al.
  • Table 1 The top ten major ribotypes with more than 60 clones and found in multiple subjects are shown in Table 1: Table 1 - Top ten most abundant ribotypes found in pilosebaceous units Ribotype Nucleotide changes from RT1 Number of subjects Number of clones Percentage of clones from acne patients a Percentage of clones from normal individuals b p- value c RT1 - 90 5536 48% 52% 0.84 RT2 T854C 48 1213 51% 49% 0.36 RT3 T1007C 60 2104 40% 60% 0.092 RT4 G1058C, A1201C 23 275 84% 16% 0.049 RT5 G1058C 15 205 99% 1% 0.00050 RT6 T854C, C1336T 11 262 1% 99% 0.025 RT7 G529A 10 188 99% 1% 0.12 RT8 G1004A, T1007C 5 239 100% 0% 0.024 RT9 G1268A
  • Ribotypes 4, 5, 7, 8, 9, and 10 were found predominantly in acne patients, with four of these six statistically significantly enriched in acne (p ⁇ 0.05, Wilcoxon test).
  • Ribotypes 4, 5, and 10 contain a nucleotide substitution G1058C in the 16S rDNA sequences, which has previously been shown to confer increased resistance to tetracycline (Ross et al . , 1998; Ross et al . , 2001).
  • HMP Human Microbiome Project
  • a comparative genome analysis among all 71 genomes grouped by ribotypes was performed.
  • the analysis revealed genetic elements by which acne-associated strains could contribute to acne pathogenesis and the elements by which health-associated strains could contribute to maintaining skin health.
  • RT4 and RT5 which had a strong association with acne
  • RT6 which was found enriched in normal skin.
  • loci 1, 2, and 3 Three distinct regions, loci 1, 2, and 3, were found almost exclusively in strains that belong to clade IA-2 in the phylogenetic tree.
  • Clade IA-2 consists of mainly RT4 and RT5 ( Figures 8 and 10 ). Loci 1 and 2 are located on the chromosome.
  • Locus 1 contains prophage-related genes and appears to be a genomic island.
  • Locus 2 has plasmid integration sites and may be derived from a plasmid sequence.
  • Locus 3 appears to be on a large mobile genetic element, likely a plasmid.
  • the plasmid is approximately 55 Kb long and has inverted terminal repeats according to the finished genome HL096PA1. The sequence data suggest that the plasmid is linear and possibly originated from a phage (Hinnebusch and Tilly (1993)).
  • RT4 and RT5 have at least 60% of the genes of the plasmid represented, and all of them have regions homologous to the inverted terminal repeats in the plasmid, suggesting that they harbor the same or a similar linear plasmid ( Figure 8 ).
  • the copy number of the plasmid in the genomes ranges from 1 to 3 based on genome sequencing coverage, which was confirmed by quantitative PCR ( Figures 11 and 12 ).
  • RT4 and RT5 strains carry a linear plasmid and two unique loci of genomic islands indicates that these plasmid and chromosomal regions play a role in acne pathogenesis.
  • the linear plasmid encodes a tight adhesion (Tad) locus, which has been suggested to play a role in virulence in other organisms (Kachlany et al. , 2000; Schreiner et al. , 2003).
  • Tad locus is found in all but one of the fifteen genomes of RT4 and RT5, and is only occasionally found in other ribotypes.
  • a Sag gene cluster is encoded, which has been shown to contribute to hemolytic activity in pathogens (Fuller et al. , 2002; Humar et al. , 2002; Nizet et al. , 2000).
  • Figure 6 summarizes the genes that are mostly unique to RT4 and RT5, several of which play essential roles in virulence in other organisms. Some of these genes encoded in RT4 and RT5 increase virulence, promote stronger adherence to the human host, or induce a pathogenic host immune response.
  • CRISPR Clustered Regularly Interspaced Short Palindromic Repeats
  • acnes consists of a series of cas genes - cas3, cse1, cse2, cse4, cas5e, cse3, cas1, and cas2, which are homologous to the CRISPR locus reported in E. coli ( Figure S10) and the CRISPR4 locus in Streptococcus thermophilus (Horvath and Barrangou, 2010).
  • CRISPR arrays are composed of a cluster of identical repetitive sequences separated by spacer sequences of similar length but with different nucleotide sequences. It has been found that spacer sequences are identical or with one or two mismatches to phage or plasmid DNA sequences. A total of 39 spacer sequences were found in eight P. acnes strains, 25 of which were unique as shown in Table 2.
  • acnes phage PA6 gp15 (minor tail protein) 5 CGGTGTTAACGGCTTGCCTGGCTTGGATGGAG No hits RT2 HL060PA 1 1 CGCCTACCGTCAGCTGACTCACGCCTCCGCGTT No hits 2 TCACACCAGTCATCAGCGTCATAGTCCTCTCGG No hits RT2 HL082PA2 1 GGCTCAGCCCTGCCCGATGCCTACGCCAAATGG C.
  • leptum DSM 753 CLOLEP_00129 (cell wall-associated hydrolases (invasion-associated proteins)) Locus 3 2 TCACACCAGTCATCAGCGTCATAGTCCTCTCGG No hits RT2 HL103PA1 1 CACCGGGCCCATCCCGGTCGGCCTCCTGAAAGG C. leptum DSM 753 CLOLEP_00135 Locus 3 RT2 HL106PA1 1 GATCGAGTTGGCTGAGTCGAAGGTGTTGCGGTT P. acnes phage PA6 gp16 (conserved protein) P.
  • acnes SK137 HMPREF0675_3193 (domain of unknown function) Locus 2 2 CAGGCGCTCCACTCCCTCGCCCTGGCCACCAAC No hits RT6 HL110PA3 HL110PA4 1 CTATGTGGACAGTGTTGGTTACTGTGGGGGGAA P. acnes phage PA6 intergenic region between gp45 and gp46 2 GCACTGCACCGATATCGTCGTGGCTGTCACTTG No hits 3 CCCAGACAACCTCGACAACCTGTTCAGGGGATG P. acnes phage PAS50 gp25 4 CATGGCTAGCCCGGATTTTTGGCTGCCTGAGCG P. acnes phage PA6 gp34 (mutidrug resistance protein-like transporters) P.
  • acnes phage PAD20 gp34 (DNA helicase) 5 CGGCCTGCGGCAGATTTTT GTTGCGTTGAATCC P. acnes phage PA6 gp14 (tape measure protein) P. acnes phage PAD20 gp14 (tape measure protein) P. acnes phage PAS50 gp14 (tape measure protein) 6 CGGGCAGAGGATGTGTTGCTCGTTCCTGGATGG P. acnes phage PA6 gp32 (CHC2 zinc finger) P. acnes phage PAD20 gp32 (DNA primase) P .
  • acnes phage PAS50 gp6 major head protein gene 8 CGAGGGCTACCACGTGGTCGATTTGGACTGTCG C. leptum DSM 753 CLOLEP_00167 Locus 2 P . acnes SK137 HMPREF0675_3193 (Domain of unknown function) 9 CAGGCGCTCCACTCCCTCGCCCTGGCCACCAAC No hits Abbreviations: BLAST, Basic Local Alignment Search Tool; CRISPR, Clustered Regularly Interspaced Short Palindromic Repeat; C. leptum, Clostridium leptum; P. acnes, Propionibacterium acnes; RT, ribotype.
  • Subjects with acne and subjects with normal skin were recruited from various clinics in Southern California including private practice, managed care, and public hospital settings, as well as outside of dermatology clinics, to best represent the diversity of populations and history of medical care.
  • the diagnosis of acne was made by board-certified dermatologists.
  • the presence of acne was graded on a scale of 0 to 5 relating closely to the Global Acne Severity Scale (Dreno et al., 2011).
  • Grades were recorded for both the face and the nose separately where zero represents normal skin and 5 represents the most severe inflammatory cystic acne.
  • the grades of the face ranged from 1 to 5 with an average of 2.1, and the grades of the nose ranged from 0 to 2 with an average of 0.3. The presence of scarring was also noted.
  • Subjects with normal skin were determined by board-certified dermatologists and were defined as people who had no acneiform lesions on the face, chest, or back. They were also excluded if they had other skin problems that the investigators felt would affect sampling or the microbial population on the skin.
  • 59 were female (31 acne patients and 28 normal subjects) and 42 were male (18 acne patients and 24 normal subjects).
  • the average age of the acne cohort was 22.2 and the average age of the normal cohort was 29.6. There was no significant difference in ethnicity between the acne and normal populations.
  • the subjects responded to a written questionnaire, administered by a physician or a well-trained study coordinator who went over each question with the subjects. Most of the subjects had not been treated for acne in the past or were not being treated when samples were collected ( Figure 3 ). Only nine out of 78 subjects, who provided treatment information, were being treated for acne when samples were taken. Among the nine subjects, two were being treated with antibiotics, five were being treated with topical retinoids, one was being treated with both antibiotics and retinoids, and one did not list the treatment. Subjects were asked for acne treatment history in the past (anytime in their life).
  • Skin microcomedone (white head or black head) samples were taken from the nose of the subjects using Bioré Deep Cleansing Pore Strips (Kao Brands Company, Cincinnati, OH) following the instruction of the manufacturer. Clean gloves were used for each sampling. After being removed from the nose, the strip was immediately placed into a 50 mL sterile tube and kept on ice or at 4 °C. The cells were lysed within four hours in most of the cases.
  • Genomic DNA was extracted using QIAamp DNA Micro Kit (Qiagen, Valencia, CA). 16S rDNA was amplified and cloned according to the protocol by HMP, which is described in detail in Supplementary Information, Nearly full length sequences were obtained by Sanger method.
  • Colonies with the macroscopic characteristics of P. acnes were picked from each sample plate and were passed twice.
  • the ribotype of each isolate was determined by PCR amplification and sequencing of the full length of the 16S rDNA gene by Sanger method.
  • Genome HL096PA1 was sequenced using Roche/454 FLX and was assembled using a combination of PHRAP/CONSED (Gordon et al. , 1998) and GSMAPPER (Roche, Branford, CT) with extensive manual editing in CONSED. The remaining 65 genomes were sequenced using Illumina/Solexa GAIIx (Illumina, San Diego, CA). Sequence datasets were processed by quality trimming and were assembled using Velvet (Zerbino and Birney, 2008). Coding sequences were predicted using GeneMark (Borodovsky and Mclninch, 1993) and GLIMMER (Salzberg et al., 1998).
  • the final gene set was processed through a suite of protein categorization tools consisting of Interpro, psort-b and KEGG. A more detailed protocol can be found at http://hmpdacc.org/doc/sops/reference_genomes/ annotation/WUGC_SOP_DACC.pdf.
  • All sequenced P. acnes genomes encode three copies of 16S rRNA genes, which are identical within each isolate, except KPA171202.
  • KPA171202 Based on the KPA171202 genome (Bruggemann et al., 2004), one copy of the 16S rRNA gene has one nucleotide difference from the other two identical copies of RT1. However, this mutation was never observed in the 16S rDNA dataset. Multiple clones of 16S rDNA gene from KPA171202 were amplified, cloned, and sequenced and a sequence harboring this mutation was not found. Thus, KPA171202 also has three identical copies of 16S rDNA.
  • RT6 (6.3%) was found to be more abundant than RT4 and RT5 combined (2.8%) in the HMP data, similar to those found in the normal cohort where RT6 represents 4.8% and RT4 and RT5 combined represent 1.2% of the clones.
  • the same five main microbiome types were observed in the two datasets ( Figure 7 ).
  • the recA gene has been widely used to classify P. acnes strains into four known types: IA, IB, II, and III (McDowell et al. , 2008; McDowell et al. , 2005).
  • the phylogenetic tree of the 71 genomes based on the SNPs in the core genome matched the recA types perfectly except one isolate, HL097PA1.
  • Most of the genomes with ribotypes 1, 4, 5, and 532 were grouped to recA Type IA clade, which can be further divided into subclades IA-1 and IA-2.
  • Clade IA-2 is composed of mostly RT4 and RT5. RT4 and most of RT5 genomes seem to belong to the same lineage with very similar genome sequences.
  • P. acnes ribotypes 4, 5, and 10 have a single nucleotide substitution G1058C in the 16S rDNA sequences, which has previously been shown to confer increased resistance to tetracycline (Ross et al., 1998a; Ross et al., 2001).
  • the substitution in the 16S rDNA sequences it was determined that all the strains of RT4 and RT5 that were sequenced have a nucleotide substitution in the 23S rDNA sequences, which confers increased resistance to a different class of antibiotics, erythromycin and clindamycin (Ross et al., 1997; Ross et al. , 1998b). It was experimentally confirmed that these isolates, except two that were unculturable, were resistant to tetracycline, erythromycin, and clindamycin.
  • PCR reactions contained 0.5 U/ ⁇ L Platinum Taq DNA Polymerase High Fidelity (Invitrogen), 1X Pre-mix E PCR buffer from Epicentre Fail-Safe PCR system, 0.12 ⁇ M concentration of each primer 27f-MP and 1492r-MP, and Sigma PCR grade water.
  • One microliter of DNA ranging from 0.2 - 10 ng total was added to each reaction.
  • the G-Storm GS4 thermocycler conditions were as following: initial denaturation of 96°C for 5 minutes, and 30 cycles of denaturation at 94°C for 30 seconds, annealing at 57°C for 1 minute, and extension at 72°C for 2 minutes, with a final extension at 72°C for 7 minutes.
  • an A-tailing reaction was performed by the addition of 1 U of GOTaq DNA Polymerase directly to the amplification reaction and incubation in the thermocycler at 72°C for 10 minutes.
  • the three PCR amplification reactions from each source DNA were pooled and gel purified (1.2% agarose gel stained with SYBR Green fluorescent dye).
  • the 1.4 Kb product was excised and further purified using the Qiagen QIAquick Gel Extraction kit.
  • the purified product was cloned into OneShot E. coli cells using TOPO TA cloning kit from Invitrogen.
  • 16S rDNA was amplified using universal primers 8F (5'-AGAGTTTGATYMTGGCTCAG-3') and 1510R (5'-TACGGYTACCTTGTTACGACTT-3') (Gao et al ., 2007). Thermocycling conditions were as following: initial denaturation step of 5 minutes at 94°C, 30 cycles of denaturation at 94°C for 45 seconds, annealing at 52°C for 30 seconds and elongation at 72°C for 90 seconds, and a final elongation step at 72°C for 20 minutes.
  • PCR products were purified using DNA Clean and Concentrator Kit (Zymo Research). Subsequently, the 16S rDNA amplicons were cloned into pCR 2.1-TOPO vector (Invitrogen). One-Shot TOP-10 Chemically Competent E. coli cells (Invitrogen) were transformed with the vectors and plated on selective media. Individual positive colonies were picked and inoculated into selective LB liquid medium. After 14 hours of incubation, the plasmids were extracted and purified using PrepEase MiniSpin Plasmid Kit (USB Corporation) or Zyppy Plasmid Miniprep Kit (Zymo Research). The clones were sequenced bidirectionally using Sanger sequencing method with 1/8th chemistry using ABI 3730 sequencer (Applied Biosystems Inc.).
  • Microcomedones on the inner surface of the nose strip were mashed and scraped using a sterile loop (Fisherbrand, Pittsburgh, PA), and plated onto a blood agar plate (Teknova Brucella Agar Plate with Hemin and Vitamin K, Teknova, Hollister, CA). The plates were incubated at 37°C for 5 - 7 days anaerobically using the AnaeroPack System (Mitsubishi Gas Chemical Company, Tokyo, Japan).
  • Colonies with the macroscopic characteristics of P. acnes were picked from each sample plate and were streaked onto A-media plates (Pancreatic Digase of Casine, Difco yeast extract, glucose, KH2PO4, MgSO4, Difco Agar, and water). These first-pass plates were then incubated anaerobically at 37°C for 5-7 days. As the second pass, single isolated colonies were picked from the first-pass plates and streaked onto new A-Media plates. These plates were then incubated anaerobically at 37°C for 5-7 days. The colonies on these plates were picked for culturing, genotyping, and genome sequencing in the subsequence steps.
  • Each isolate was analyzed by PCR amplification of the 16S rDNA gene.
  • the ribotypes were determined based on the full length sequences. Isolates with desired ribotypes were selected for future culturing and genome sequencing.
  • Isolates were grown in 5 mL of Clostridial medium under anaerobic conditions at 37°C for 5 - 7 days. Cultures were pelleted by centrifugation and washed with 3 mL phosphate buffer saline (PBS). The same protocol used for the metagenomic DNA extraction was used for extracting the genomic DNA of the isolates.
  • PBS phosphate buffer saline
  • Metagenomic DNA samples from microcomedone samples from 22 individuals with normal skin were pooled and sequenced using Roche/454 FLX. The average read length was 236 bp. The sequencing was limited with 13,291 sequence reads. Sequence reads were aligned against the NCBI's non-redundant database using BLAST. Species assignment was based on 97% identity and 100% of the read length aligned.
  • sequences with at least 99% identity over 1,400 nucleotides to P. acnes KPA171202 (Bruggemann et al ., 2004) 16S rDNA were trimmed to positions 29-1483 (numbering based on the E. coli system of nomenclature (Brosius et al ., 1978)). Sequences without full coverage over this region were excluded from further strain level analysis. Chimera screening, as described above, resulted in removal of less than 0.35% of the sequences. This may be an under-estimation of the chimeras, since the majority of sequences differ by only 1 or 2 nucleotides.
  • QIIME Caporaso et al ., 2010b was used to cluster the sequences into OTUs using 99% identity cutoff, furthest neighbor, and UCLUST (Edgar, 2010). Representative sequences (most abundant) were selected and aligned using PYNAST (Caporaso et al. , 2010a) to the greengehes database. Taxonomy was assigned using RDP method (Cole et al ., 2009). The alignment was filtered with the lanemask provided by greengenes, and a phylogenetic tree was built using FastTree (Price et al ., 2009).
  • the number of clones of each of the top ten ribotypes was normalized by the total number of P. acnes clones of the sample.
  • the normalized counts were used to test the significance in enrichment between the acne group and the normal group.
  • the function wilcox_test in the R program http://www.R-project.org) was used to calculate the p-values.
  • Microbiome types were assigned based on the largest clades seen when samples were clustered using thetayc similarity in MOTHUR (Schloss et al. , 2009) ( Figures 5 and 6 ) or hierarchical clustering (Eisen et al. , 1998) ( Figure 7 ).
  • Sequences were assigned to a ribotype if they met the following criteria. First, there was a single best match. Second, it covered the range required to discriminate between the top 45 ribotypes (58-1388). Third, there were no Ns at discriminatory positions. Lastly, there were no more than ten non-discriminatory differences.
  • the genome was sequenced using Roche/454 FLX at the UCLA Genotyping and Sequencing Core. A total of 590,054 sequence reads were generated with an average read length of 230 bp. Of these, 433,896 were assembled into two contigs, a circular main chromosome of 2,494,190 bp and a linear plasmid of 55,585 bp. Assembly was accomplished by a combination of PHRAP/CONSED (Gordon et al ., 1998) and GSMAPPER (Roche) with extensive manual editing in CONSED.
  • GeneMark v2.6r (Borodovsky and Mclninch, 1993) and GLIMMER v2.0 (Salzberg et al ., 1998) were used to performed ab initio protein coding gene prediction.
  • tRNAScan-SE 1.23 was used for tRNA identification and RNAmmer was used for predicting ribosomal RNA genes (5S, 16S, and 23S).
  • Genome annotation results were based on automated searches in public databases, including Pfam (http://pfam.jouy.inra,fr/), KEGG (http://www.genome.jp/kegg), and COG (http://www.ncbi.nlm.nih.gov/COG/). Manual inspection of the annotation was also performed.
  • the genomes were sequenced using Illumina/Solexa Genome Analyzer IIx and annotated by the Genome Center of Washington University at St. Louis.
  • Each genomic DNA sample was randomly sheared and an indexed library was constructed using standard Illumina protocols. Twelve uniquely tagged libraries were pooled and run on one lane of a GAIIx flowcell and paired end sequences were generated. Following deconvolution of the tagged reads into the separate samples, datasets were processed using BWA (Li and Durbin, 2009) quality trimming at a q10 threshold.
  • BWA Li and Durbin, 2009
  • Coding sequences were predicted using GeneMark v3.3 (Borodovsky and Mclninch, 1993) and GLIMMER v2.13 (Salzberg et al ., 1998). Intergenic regions not spanned by GeneMark and GLIMMER were aligned using BLAST against NCBI's non-redundant database and predictions were generated based on protein alignments. tRNA genes were determined using tRNAscan-SE 1.23 and non-coding RNA genes were determined by RNAmmer-1.2 and Rfam v8.0. The final gene set was processed through a suite of protein categorization tools consisting of Interpro, psort-b and KEGG. The gene product naming comes from the BER pipeline (JCVI). A more detailed standard operating protocol (SOP) can be found at http://hmpdacc.org/doc/sops/reference_genomes/annotation/WUGC_SOP_DACC.pd f.
  • SOP standard operating protocol
  • the “core” regions were defined as genome sequences that are present in all 71 genomes.
  • P. acnes KPA171202 was used as the reference genome.
  • Each of the other 70 genome sequences (a series of contigs in most of the genomes and two complete genomes) was mapped to the reference genome using Nucmer (Kurtz et al ., 2004).
  • All the 70 ".coords” output files of Nucmer program were analyzed to identify overlap regions based on the KPA171202 coordinates using a Perl script.
  • “core” sequences were extracted based on the genome sequence of KPA171202 with the coordinates calculated above. On average, 90% (ranging from 88% to 92%) of the genomes were included in the core regions.
  • SNPs Single nucleotide polymorphisms
  • Genome sequence of P. acnes KPA171202 was used as the reference genome. All the 70 ".snps" output files of Nucmer program were analyzed to identify unique SNP positions based on the KPA171202 coordinates using a Perl script. The SNPs in the core regions were further analyzed to construct a phylogenetic tree.
  • the 71 concatenated sequences of the 96,887 SNP nucleotides in the core regions were used to construct a phylogenetic tree of the P. acnes genomes.
  • the evolutionary distance of the core regions among the genomes was inferred using the Neighbor-Joining method (Saitou and Nei, 1987).
  • the bootstrap tree inferred from 1,000 replicates was taken. Branches corresponding to partitions reproduced in less than 80% bootstrap replicates were collapsed.
  • Figure 8 shows only the topology.
  • Figure 9 the tree was drawn to scale, with branch lengths in the same units as those of the evolutionary distances used to infer the phylogenetic tree.
  • the evolutionary distances were computed using the p-distance method and are in the units of the number of nucleotide differences per site. This tree shows the comparison based on only the core regions. The distance does not represent the true evolutionary distance between different genomes, since the non-core regions of each genome were not considered here. All positions containing gaps and missing data were eliminated. Evolutionary analysis was conducted using MEGA5 (Tamura et al ., 2007).
  • CRISPRFinder (Grissa et al ., 2007) was used to identify the CRISPR repeat-spacer sequences.
  • the annotation of HL110PA3 was used for BLAST alignment in order to identify the presence of CRISPR/Cas structure and CRISPR repeat-spacer sequences in strains of HL001PA1, HL060PA1, HL082PA2, HL103PA1, HL106PA1, HL110PA4 and J139.
  • Each spacer sequence was annotated by BLAST alignment against NCBI's non-redundant nucleotide database and the reference genomic sequences database (refseq_genomic).
  • MAQ (Li et al ., 2008) was used to map the raw sequence reads from Illumina/Roche platform to the reference genomes. Briefly, “map” command was used for mapping, and “assemble” command was used for calling the consensus sequences from read mapping, then “cnd2win” command was used to extract information averaged in a tilling window. A window size of 1,000 bp was used. Randomly selected 1 million reads were used for mapping. This accounted for approximately 40X coverage for all the genomes except HL096PA2, HL096PA3, HL097PA1 and HL099PA1, which had approximately 55X to 75X coverage. BWA (Li and Durbin, 2010) was used to map the raw sequence reads from Roche/454 platform to the reference genome HL096PA1. The average coverage was calculated in 1,000 bp window.
  • Quantitative PCR targeting TadA on the plasmid (Locus 3) and housekeeping genes Pak and RecA on the chromosome was performed using the genomic DNA extracted from the P. acnes isolates.
  • LightCyler 480 High Resolution Melting Master kit was used (Roche Diagnostics GmbH, Mannheim, Germany). Each 10 ⁇ L reaction solution was consisted of 5 ⁇ L master mix (2X concentrate), 1 ⁇ L 25 mM MgCl2, 0.5 ⁇ L 4 ⁇ M forward and reverse primers, and DNA template.
  • Four qPCR runs were performed on Roche LightCycler 480.
  • Primer sequences for TadA are 5'-GATAATCCGTTCGACAAGCTG-3' (forward) and 5'-ACCCACCACGATGATGTTT-3' (reverse).
  • Primer sequences for pak are 5'-CGACGCCTCCAATAACTTCC-3' (forward) and 5'-GTCGGCCTCCTCAGCATC-3' (reverse).
  • Primer sequences for recA are 5'-CCGGAGACAACGACAGGT-3' (forward) and 5'-GCTTCCTCATACCACTGGTCATC-3' (reverse). All samples were run in duplicates in each qPCR run, except the second run, which was not duplicated.
  • Thermocycling conditions were as following: initial activation step of 10 minutes at 95oC; 50 amplification cycles with each consisting of 10 seconds at 95oC, 15 seconds at 65oC in the first cycle with a stepwise 0.5oC decrease for each succeeding cycle, and 30 seconds at 72oC; and final melting curve step starting at 65oC and ending at 99oC with a ramp rate of 0.02 oC/s and acquisition rate of 25/oC.
  • DNA concentration standards were run in duplicates. Copy number ratios of genes were calculated based on the concentrations of the genes on the plasmid and chromosome.
  • 16S rDNA sequences have been deposited at GenBank under the project ID 46327.
  • Whole genome shotgun sequences and annotations of the P. acnes strains have been deposited at GenBank under the accession numbers ADWB00000000, ADWC00000000, ADWF00000000, ADWH00000000, ADWI00000000, ADXP00000000, ADXQ00000000, ADXR00000000, ADXS00000000, ADXT00000000, ADXU00000000, ADXW00000000, ADXX00000000, ADXY00000000, ADXZ00000000, ADYA00000000, ADYB00000000, ADYC00000000, ADYD00000000, ADYE00000000, ADYF00000000, ADYG00000000, ADYI00000000, ADYJ00000000, ADYK00000000, ADYL00000000, ADYM00000000, ADYN00000000, ADY000000000, ADYP00000000, ADYQ00000000, ADYR00000000, ADYS0000, ADYT00000000, ADY
  • Propionibacterium acnes is a major human skin bacterium. To understand whether different strains have different virulent properties and thus play different roles in health and diseases, the genomes of 82 P. acnes strains, most of which were isolated from acne or healthy skin, were compared. Lineage-specific genetic elements were identified that may explain the phenotypic and functional differences of P. acnes as a commensal in health and as a pathogen in diseases. By analyzing a large number of sequenced strains, an improved understanding of the genetic landscape and diversity of the organism at the strain level and at the molecular level is provided.
  • Propionibacterium acnes is a major commensal of the human skin. It contributes to maintaining the skin health by inhibiting the invasion of common pathogens, such as Staphylococcus aureus and Streptococcus pyogenes. It does so by hydrolyzing triglycerides and releasing free fatty acid that contributes to the acidic pH of the skin surface (1).
  • P. acnes has been historically linked to acne vulgaris, a chronic inflammatory disease of the pilosebaceous unit affecting more than 85% of adolescents and young adults (2).
  • a metagenomic study previously demonstrated that P . acnes was a dominant bacterium in the pilosebaceous unit in both healthy individuals and acne patients (3, 4). At the strain level, however, the population structures of P. acnes were different between the two groups.
  • P. acnes has been classified into three distinct types. Studies by Johnson and Cummins (7) first revealed two distinct phenotypes of P. acnes, known as types I and II, that could be distinguished based on serological agglutination tests and cell wall sugar analysis. McDowell et al . (8) differentiated types I and II P . acnes by monoclonal antibody typing. Furthermore, their phylogenetic analysis of P. acnes strains based on the nucleotide sequences of the recA gene and a more variable hemolysin/cytotoxin gene (tly) demonstrated that types I and II represent distinct lineages. Their investigations also revealed that strains within the type I lineage could be further split into two clades, known as types IA and IB (8, 9).
  • P. acnes An additional phylogenetic group of P. acnes, known as type III was described later (10). Recent studies based on multilocus sequence typing (MLST) further sub-divided P. acnes into closely related clusters, some of which were associated with various diseases including acne (11-13).
  • MMT multilocus sequence typing
  • the first complete genome sequence of P. acnes, KPA171202, a type IB strain provided insights on the pathogenic potential of this Gram-positive bacterium (14).
  • the genome is 2.56 M bp with 60% of GC content. It encodes 2,333 open reading frames (ORFs) including multiple gene products involved in degrading host molecules, such as sialidases, neuraminidases, endoglycoceramidases, lipases, and pore-forming factors.
  • ORFs 2,333 open reading frames
  • the sequence of a single genome does not reflect the genetic landscape of the organism and how genetic variations among strains determine their various phenotypes and pathogenic properties.
  • HMP Human Microbiome project
  • the 69 strains included 19 RT1 strains, five RT2 strains, 15 RT3 strains, eight RT4 strains, seven RT5 strains, four RT6 strains, six RT8 strains, four strains of minor ribotypes, and one type III strain.
  • the average genome size was 2.50 Mb (ranging from 2.46 to 2.58 Mb) and the GC content was 60%.
  • each genome encoded 2,626 ORFs (ranging from 2,393 to 2,806) (Table 2-1).
  • These 13 genomes include six RT1 strains, two RT2 strains, four RT3 strains, and one RT5 strain, however, no genomes of RT4, RT6, RT8 and type III strains were available.
  • pan-genome based on the 82 P. acnes genomes was estimated.
  • the number of new genes that would be discovered by sequencing additional P . acnes genomes by using a power law regression analysis, n ⁇ N ⁇ (24), was estimated ( Figure 13 ).
  • the average number of new genes added by a novel genome was three when the 82nd genome was added.
  • the number of P. acnes pan-genes that would be accumulated by sequencing additional P. acnes genomes by using a power law regression analysis, n ⁇ N ⁇ , was then estimated ( Figure 14 ).
  • pan-genome of P. acnes is defined as open, as the exponent ⁇ was less than one and ⁇ was greater than zero (24). However, since ⁇ was close to one and ⁇ was close to zero, it is believed that this organism evolved tightly without large expansions.
  • a genome comparison of the 82 P. acnes strains revealed that 2.20 Mb (88% of the average genome) was shared by all the P. acnes genomes, which are referred to herein as the "core regions.”
  • 123,223 unique single nucleotide polymorphisms SNPs
  • Twenty seven percent of the SNPs were unique to type I, 22% were unique to type II, and 22% were unique to type III ( Figure 15 ).
  • a phylogenetic tree based on the 123,223 SNPs in the core regions was constructed ( Figure 16 ). The tree showed that the recA type classification of the strains was consistent with the major clades based on the genomes.
  • the recA type IA, IB, and II strains were all clustered together within each type, respectively, except HL097PA1 and PRP-38.
  • the only recA type III strain, HL201PA1 formed a separate branch from type I and type II strains.
  • the tree also showed that the16S rRNA ribotypes of the strains were consistent with the phylogenetic relationships inferred from the genome sequences.
  • Most of the RT1 strains were clustered in clade IA-1, while all the RT4 and most of the RT5 strains were clustered in clade IA-2. All six RT8 strains were clustered together in clade IB-1.
  • RT3 and RT16 strains were clustered together in clade IB-2 except SK187.
  • HL030PA1 and KPA171202 were clustered together with 6609, as a distinct IB-3 clade.
  • HL097PA1and PRP-38 were clustered together and were classified as a novel type IC recently named by McDowell et al. (22).
  • All the RT2 strains were clustered in clade II, distant from clade I, together with RT6 strains.
  • HL202PA1 which is a RT6 strain and was isolated from an oral site, was not much different from the skin RT6 isolates and was clustered together.
  • acnes strains included 49 SSIs: 13 duets ( i.e ., 13 pairs of strains isolated from 13 individuals), five trios, and two quartets. Twenty three SSIs were clustered in the same clades, nine in clade IA-1, four in clade IA-2, two in clade IB-1, six in clade IB-2 and two in clade II. The distance (substitution rate at the 123,223 SNP sites in the core regions) between each pair of SSIs was calculated ( Figure 16 ). The average distance of the SSIs in clade IA-1 was 0.0014, while that of strains from different individuals in clade IA-1 was 0.0064 (P ⁇ 0.001).
  • RT4 and RT5 strains may be transmitted among individuals. This finding is consistent with the previous clinical report that antibiotic-resistant Propionibacteria were transmissible between acne-prone individuals including dermatologists (26), as most of the antibiotic-resistant P. acnes strains belong to RT4 and RT5 (4,13).
  • the analysis of SSIs further supports the theory that RT4 and RT5 strains may be a pathogenic factor in acne.
  • non-core genome regions were identified that were not shared by all 82 strains.
  • the total length of the non-core regions was approximately 0.90 Mb.
  • the average GC content of the non-core regions was slightly lower than that of the core regions, 58% ⁇ 6.9%, suggesting that part of the non-core regions might be originated from other species via horizontal gene transfer.
  • GI2 genomic island-like cluster 2
  • Clade IB-1 consisted of all RT8 strains, which were also highly associated with acne based on our metagenomic study (4). They all have a unique genomic island (locus 4), which is 20 Kb long and encodes a series of nonribosomal peptide synthetases (NRPS), which may contribute to increased virulence of these strains. Most RT3 and RT16 strains belong to clade IB-2 and have fewer non-core regions than the strains in other clades.
  • locus 3 a linear plasmid, which is highly homologous to the locus 3 in the RT4 and RT5 strains of clade IA-2 and encodes a tight adhesion locus originated from Clostridium leptum (4).
  • locus 3 a linear plasmid, which is highly homologous to the locus 3 in the RT4 and RT5 strains of clade IA-2 and encodes a tight adhesion locus originated from Clostridium leptum (4).
  • strains in different lineages had a similar genome size with similar gain and loss of genetic materials, they harbor distinct genetic elements which may give rise to their different virulent properties.
  • RT2 and RT6 were more distantly related to the strains in clade I. Based on the metagenomic study, strains in clade II were not associated with acne, as RT2 was evenly distributed between acne patients and healthy individuals, while RT6 was significantly enriched in healthy individuals (4). Compared to type I strains, the genomes of RT2 and RT6 strains lack several regions, which are approximately 92 Kb long in total and encode 107 ORFs. RT2 and RT6 genomes have additional genomic regions with a similar size encoding 93 ORFs ( Figure 20 ). Based on the COG classification, there were no significant differences in the distribution of the functional categories between the 107 type I specific ORFs and 93 type II specific ORFs.
  • CRISPR clustered regularly interspaced short palindromic repeats
  • CRISPR/Cas locus The most unique genomic feature of RT2 and RT6 strains is represented by the clustered regularly interspaced short palindromic repeats (CRISPR)/Cas locus (4).
  • CRISPR/Cas system provides acquired bacterial immunity against viruses and plasmids by targeting nucleic acids in a sequence-specific manner (28). All the sequenced strains of RT2 and RT6 encoded a complete set of CRISPR/Cas genes and at least one repeat and spacer sequence, while none of the other ribotype strains did. Based on its complete genome sequence (20), strain ATCC11828 appeared to be an exception, having only terminal sequence but no spacer sequence. However, using PCR and sequencing it was determined that ATCC11828 has one repeat-spacer sequence (Table S2).
  • loci 2 and 3 multiple type II strains harbored spacer sequences that match to the sequences in loci 2 and 3, which were unique to mainly acne-associated RT4 and RT5 strains (4).
  • the sequences in loci 2 and 3 appeared to be originated from C. leptum and encode potential virulence factors (Fig. S4). These loci may have been acquired by RT4 and RT5 strains, while the genomes of RT2 and RT6 that encode these spacers may be capable of eliminating the invasion of foreign DNA through the CRISPR mechanism (4).
  • Type III strains are rarely found on the skin surface.
  • a type III P. acnes strain isolated from refractory endodontic lesion, HL201 PA1 was sequenced. This first available type III genome permitted the identification of the genetic elements specific to this lineage. Compared to type I and type II strains, the genome of HL201 PA1 lacks a few regions with a total length of 43 Kb ( Figure 20 ).
  • ORFs encoded in these regions including anaerobic dimethyl sulfoxide reductase (PPA0516-PPA0517), iron(III) dicitrate transport system permease (PPA0792-PPA0793), 3-isopropylmalate dehydratase (PPA1361-PPA1363), and maltose transport system permease (PPA1553-PPA1554).
  • This study presents a comparative genome analysis of a major skin commensal, P. acnes, based on a large number of sequenced strains. This collection of strains not only includes strains associated with either healthy skin or acne, but also a large number of strain pairs that were isolated from the same individuals. This allowed the comparison of phylogenetic relationships and microevolution of the P. acnes strains associated with health vs. disease as well as of the strains in the same individual microbiome.
  • 16S ribotyping has a much higher resolution than recA typing and is much easier and faster than the traditional MLST method.
  • This method can be applied in a high-throughput manner by combining with next-generation sequencing, and thus allows one to detect the microbiome variations at the strain level (4). This is advantageous and important, as identifying and understanding the strain level variations of the human microbiome is medically important.
  • RT4 and RT5 strains encode three distinct loci originated from mobile elements
  • RT8 strains encode a distinct region containing a set of NRPS.
  • the virulent genes encoded in these strain-specific regions may explain the associations of these strains with acne and help the development of new drugs targeting against these strains.
  • RT2 and RT6 strains which were not associated with acne and were enriched in healthy skin, respectively, all encode CRISPR/cas elements. The CRISPR mechanism may prevent these strains from acquiring virulent genes from invading foreign mobile elements.
  • these strains contain genomic variations in lipases that may alter lipid metabolism and reduce their virulence ( Figure 22 ).
  • HL042PA3 The genome of HL042PA3 was sequenced using Roche/454 FLX and assembled using a combination of PHRAP/CONSED (32) and GSMAPPER (Roche).
  • HL201PA1 and HL202PA1 were sequenced using Illumina MiSeq (250 bp, paired-end) and assembled using Velvet (33).
  • the remaining 66 genomes were sequenced previously as described (4). Coding sequences were predicted using GeneMark (34) and GLIMMER (35).
  • the core regions were defined as genome sequences that were present in all 82 genomes, while the non-core regions were defined as genome sequences that were not present in all the genomes.
  • KPA171202 was used as the reference genome. Each of the other 81 genome sequences (a series of contigs in most of the genomes and ten complete genomes) was mapped to the reference genome using Nucmer (36). All the 81 ".coords" output files of Nucmer program were analyzed to identify overlap regions based on the KPA171202 coordinates using a Perl script. Core sequences were then extracted based on the genome sequence of KPA171202 with the coordinates calculated above.
  • SNPs Single nucleotide polymorphisms
  • the 82 concatenated sequences of the 123,223 SNP nucleotides in the core region were used to construct a phylogenetic tree of the P. acnes genomes.
  • MEGA5 (37) was used to calculate the distance based on the SNPs in the core regions using the Neighbor-Joining method and the p-distance method.
  • the bootstrap tree inferred from 200 replicates was taken.
  • sequence types of the 82 isolates were determined based on the MLST schemes published previously (11-13).
  • the MLST gene sequences were aligned using BLAST against all the alleles used in the two MLST schemes.
  • CRISPRFinder (38) was used to identify the CRISPR repeat-spacer sequences.
  • the annotation of HL110PA3 was used for BLAST alignment in order to identify the presence of CRISPR/Cas structure and CRISPR repeat-spacer sequences in strains of HL001PA1, HL060PA1, HL042PA3, HL082PA2, HL103PA1, HL106PA1, HL110PA4, HL202PA1, J139 and ATCC11828.
  • Each spacer sequence was annotated by BLAST (39) against NCBI's non-redundant nucleotide database and the reference genomic sequences database (refseq_genomic).
  • Skin microcomedone (white head or black head) samples were taken from the skin of the subjects using a specialized adhesive tape. The skin was moistened with water before the adhesive tape was put on. The tape was left on the skin for 15-20 minutes until it became dry. Clean gloves were used for each sampling. After being taken off from the skin, the tape was placed into a 50 mL sterile tube. This can be applied to many skin sites, such as the nose, forehead, chin, and back.
  • Microcomedones were individually picked or scraped off from the adhesive tape using sterile forceps and placed in a 2 mL sterile microcentrifuge tube filled with Buffer ATL (Qiagen) and 0.1mm diameter glass beads (BioSpec Products, Inc., Bartlesville, OK). Cells were lysed using a beadbeater for 3 minutes at 4,800 rpm at room temperature. After centrifugation at 14,000 rpm for 5 minutes, the supernatant was retrieved and used for genomic DNA extraction using QIAamp DNA Micro Kit (Qiagen). The manufacturer protocol for extracting DNA from chewing gum was used. Concentration of the genomic DNA was determined by a spectrometer.
  • 16S rDNA was amplified using primers 8F (5'-AGAGTTTGATYMTGGCTCAG-3') and 1510R (5'-TACGGYTACCTTGTTACGACTT-3'). Thermocycling conditions were as following: initial denaturation step of 5 minutes at 94°C, 30 cycles of denaturation at 94°C for 45 seconds, annealing at 52°C for 30 seconds and elongation at 72°C for 90 seconds, and a final elongation step at 72°C for 20 minutes. PCR products were purified using column-based method. Subsequently, the 16S rDNA amplicons were cloned into pCR 2.1-TOPO vector (Invitrogen).
  • E. coli cells (Invitrogen) were transformed with the vectors and plated on selective media. Individual positive colonies were picked and inoculated into selective LB liquid medium. After 14 hours of incubation, the plasmids were extracted and purified, either using column-based plasmid extraction kit or traditional methods. The clones were sequenced bidirectionally using Sanger sequencing method. The microbiome type of each individual was determined based on the 16S rDNA sequence data of the top 10 major ribotypes. See Figure 5 and SEQ ID NOs 1-10.
  • PCR primer sequences are shown in Table 1: Table 1 - Primers specific for loci 1, 2, 3 and Pak (housekeeping gene) Target locus Forward primer Reverse primer Locus 1 GGTATCCACCGAGATGGAAG (SEQ ID NO:11) GTGGTCCCAGGTGACATTCT (SEQ ID NO:12) Locus 2 CGACATCGACGTTTCATCTG (SEQ ID NO:13) GTGTTCTCCTCGTGCTGGTT (SEQ ID NO:14) Locus 3 GATAATCCGTTCGACAAGCTG (SEQ ID NO:15) ACCCACCACGATGATGTTT (SEQ ID NO:16) Pak CGACGCCTCCAATAACTTCC GTCGGCCTCCTCAGCATC
  • Additional primers targeting these loci can be designed based on the genome sequences of loci 1-4 (SEQ ID NOs 15-18, respectively).
  • Each 20pL reaction contains 12.7 ⁇ L molecular grade H2O, 2 ⁇ L 10X High Fidelity Buffer, 0.6 ⁇ L 50mM MgSO4, 0.4 ⁇ L 10nM dNTP, 0.8 ⁇ L of each primer (final primer concentrations is 400nM), 0.1 ⁇ L Platinum Taq DNA Polymerase High Fidelity (All reagents from Invitrogen) and 1 ⁇ l gDNA template (approx. 40ng gDNA).
  • thermocycling conditions are as following: initial denaturation step of 10 minutes at 95°C; 35 cycles with each consisting of 45 seconds at 95°C, 30 seconds at 65°C and 45 seconds at 72°C; and final elongation step of 10 minutes at 72°C.
  • thermocycling conditions were as following: initial activation step of 10 minutes at 95 oC; 40 amplification cycles with each consisting of 10 seconds at 95°C, 15 seconds at 65 oC during first cycle, but with a stepwise 0.5°C decrease for each succeeding cycle and 30 seconds at 72°C; and finally, a melting curve step, starting at 65°C and ending at 99°C, with ramp rate of 0.02°C/s and acquisition rate of 25 per °C.
  • the concentration of each locus was quantified from standards derived from Locus 1, Locus 2, and Pak PCR amplicons.
  • the copy number of each gene was quantified from genomic DNA standards that were derived from TadA (in Locus 3) and Pak amplicons using conventional PCR. See Figure 24 .
  • a triplex Taqman qPCR was designed and tested using Propionibacterium specific primers to target Locus 1, Locus 3, and an internal control, Pak, present in all P. acnes.
  • Benchtop amplification was carried out to assess specificity of designed primers and to determine optimum cycling conditions prior to multiplexing. Amplification was carried out using a BioRad C1000 thermal cycler. Singleplex PCR reactions contained 0.2 ⁇ M target specific primers, 10X Platinum Taq buffer (Invitrogen), 1.0 mM MgCl2, 0.2 mM each dNPT, 0.5U/ ⁇ l Platinum Taq polymerase, 1 ⁇ l DNA template and made up to a final volume of 10 ⁇ l.
  • Triplex qPCR was carried out using an Applied Biosystems 7900HT instrument. 1-2 ⁇ l of sample DNA were added to mastermix containing X2 QuantiTect Multiplex PCR Master Mix (Qiagen), 0.2 ⁇ M primers; Locus1_F, Locus1_R, Pak_F, Pak_R; 0.2 ⁇ M probes; Locus1_Probe and Pak_Probe, and 0.1 ⁇ M primers Locus3_F and Locus3_R, and 0.1 ⁇ M Locus3_Probe. The reaction mix was made up to a final volume of 20 ⁇ l with sterile PCR grade water.
  • the PCR program consisted of one cycle at 50°C for 2 minutes, followed by one cycle at 95°C for 15 minutes to allow for activation of the multiplex mastermix, then 45 cycles of 94°C for 60 seconds and 57°C for 90 seconds.
  • Each run contained calibrators of extracted P. acnes DNA from culture, as well as no-template controls (NTC) and water controls.
  • qPCR was run with a passive reference, ROX, supplied in the Quantitect Multiplex PCR mastermix. Data were analysed using the SDS v2.4 software.
  • Calibrations curves for P. acnes targets Locus 1 and Pak were constructed by plotting mean Ct values for a series of log dilutions of quantified genomic DNA standards extracted from P. acnes from pure culture. Genome equivalents were estimated. Five replicates of P. acnes calibrators were used to calculate mean Ct values and standard deviations. These data were used to determine sensitivity of the assay and the limits of detection (LOD). Calibration plots were used to determine the number of P. acnes genomes in clinical samples, with one copy of Locus1 and Pak targets per genome. DNA concentration and copy number were determined and serial ten-fold dilutions of the purified product were used as standards for construction of the Locus3 calibration plot.
  • Locus1 and Locus 3 were used for Locus1 and Pak calibration: HL038PA1 (Locus1+, Locus3+), HL083PA1 (Locus1+, Locus3-), HL078PA1 (Locus1-, Locus3+) and HL063PA1 (Locus1-, Locus3-).
  • the assay was validated using sequenced P. acnes strains from pure culture with known loci before being applied to clinical samples. The specificity of the assay for each target was tested using other bacterial species including skin commensals and other Propionibacteria.
  • EXAMPLE 6 Probiotic development utilizing the strains associated with healthy skin in topical creams, solutions, and the like for cosmetic and other products
  • RT6 is mostly found in healthy skin. These strains can be used as probiotics in topical products for acne prevention and treatment. Four RT6 strains, including HL110PA3, HL110PA4, HL042PA3, and HL202PA1, were isolated and sequenced.
  • bacterial culture supernatant and/or cell lysate can be used in creams, solutions, and other cosmetic products to prevent the growth of strains associated with acne. Sequences sharing at least 95% homology with SEQ ID NOs 51-54 may be used for the development of probiotics and the like.
  • the "core” genome regions of P. acnes were defined as genome sequences that are present in all of the 82 genomes, while the “non-core” regions were defined as genome sequences that are NOT present in all the genomes. See S. Tomida et al ., Pan-genome and Comparative Genome Analyses of Propionibacterium acnes Reveal Its Genomic Diversity in the Healthy and Diseased Human Skin Microbiome (in press); see also Example 2. Non-core regions specific to strains of RTs 4 and 5, e.g., loci 1, 2, and 3, were identified, as mentioned previously.
  • Non-core regions specific to strains of RT8 were also identified as well as several other strains such as HL078PA1, HL030PA2, HL063PA2, P.acn17, HL097PA1, and PRP38. See Figure 20 .
  • the genomic sequence of Locus 4 is set forth as SEQ ID NO:18.
  • the genes in loci 1-4 below (Tables 4-1, 4-2, and 4-3) that are mostly unique to acne associated strains RT4, RT5, and RT8 are listed below.
  • Non-core sequences are also set forth. The genes encoded in these loci are drug targets.
  • Bacteriophages play an important role in regulating the composition and dynamics of microbial communities, including the human skin microbiota. Bacteriophages of Propionibacterium acnes, a major skin commensal, were previously isolated and used as a typing system to distinguish different serotypes of P. acnes. However, molecular characterization of these phages had been lacking. Recent efforts in genome sequencing have improved our understanding of P. acnes phages and their interactions with bacterial hosts.
  • Bacteriophages are the most abundant organisms on earth (Mc Grath & van Sinderen, 2007) and are believed to outnumber bacteria by 10:1 in many diverse ecosystems (Rohwer, 2003). As important components of microbial communities, bacteriophages are a reservoir of diversity-generating elements (Rohwer & Thurber, 2009) and regulate both the abundances (Suttle, Chan, & Cottrell, 1990) and diversity of microbial hosts by predation (Rodriguez-Valera et al. , 2009). The human skin is inhabited by hundreds of microbial species, including bacteria, fungi, and viruses (Grice & Segre, 2011).
  • the homeostasis of this ecosystem is important to its function as a barrier against the invasion and colonization of pathogens on the skin.
  • the relative abundances and interactions between bacteriophages and their bacterial hosts on the skin remained to be elucidated.
  • P. acnes The microbial community in the pilosebaceous unit of the skin is dominated by Propionibacterium acnes, which accounts for approximately 90% of the microbiota ("(Nature Precedings Paper)," n.d.).
  • P. acnes has been suggested as a pathogenic factor in the development of acne vulgaris (Bojar & Holland, 2004; Leyden, 2001), one of the most common human skin diseases.
  • Above-detailed studies classified P. acnes strains into ribotypes (RT) based on their 16S ribosomal RNA (rRNA) sequences, and demonstrated that P. acnes strain population structure in pilosebaceous units differs between healthy skin and acne affected skin.
  • RT ribotypes
  • rRNA 16S ribosomal RNA
  • P. acnes bacteriophages exist on the human skin.
  • Zierdt et al. Zierdt,Webster, & Rude, 1968 isolated such a phage, named phage 174, from spontaneous plaques of a P. acnes isolate (at the time known as Corynebacterium acnes).
  • Phage 174 was able to lyse nearly all P. acnes strains tested in the study [10].
  • P. acnes phages were isolated which exhibited varied life cycles that range from lytic to temperate [11, 12].
  • the study of P. acnes bacteriophages had been limited to the development of phage typing systems to distinguish the different serotypes of P. acnes [13, 14]_ENREF_4, and extensive molecular characterization of the phages has been lacking.
  • acnes phages have diverse host specificities among different lineages of P. acnes strains [14]. Phage host specificity is important in determining how these phages regulate the composition and dynamics of P. acnes populations in the community. On the other hand, certain P. acnes strains may also influence phage populations through their anti-viral mechanisms, such as the bacterial Immune system based on the transcription of clustered, regularly-interspaced short, palindromic repeat (CRISPR) sequence arrays.
  • the CRISPR arrays contain oligonucleotide 'spacers' derived from phage DNA or plasmid DNA.
  • CRISPR-associated (Cas) proteins In a manner analogous to RNA interference, the transcribed, single-stranded CRISPR RNA elements interact with CRISPR-associated (Cas) proteins to direct the degradation of DNA targets containing complementary 'protospacer' sequences from foreign DNA [16]. While characterizing the genome diversity of P. acnes, Applicants discovered that P. acnes strains of RT2 and RT6 harbor CRISPR arrays. The CRISPR mechanism may play a role in defending against phage or plasmid invasion.
  • Group I consists of PHL066M04, PHL010M04, and PHL073M02, which are separated by an average phylogenetic distance of 0.002 at the genome level.
  • Group II consists of PHL085M01, PHL085N00, PHL115M02, and PHL037M02, with an average phylogenetic distance of 0.004.
  • the sites of sequence variation among Group I phages lie primarily within the region encoding a putataive type II holin and a peptidoglycan amidase (Gp20 and Gp21 as annotated in PA6, Figure 33 ). These endolysins permeabilize the membrane and degrade the extracellular peptidoglycan layer to release new phage particles from the bacterial host.
  • the majority of the sequence variations in these two genes among the Group I phage genomes are mostly synonymous and do not appear to affect the functions of the proteins.
  • the genomes of PHL010M02 and PHL066M02 differ at only 11 sites, 9 of which occur in predicted coding regions.
  • Group II members reside in a region encoding homologs of Gp16, Gp17, and Gp18 in PA6 ( Figure 33 ). These proteins' location near the 3' end of the left arm between structural proteins and lysis proteins suggests that they may be late-acting genes involved in viral protein processing and packaging.
  • P. acnes phage strains provided an opportunity to validate and refine initial annotations of the P. acnes phage genomes. Based on the analysis, several alternative annotations of the phage genomes were confirmed.
  • the minus-strand Gp22/23 ORFs from most genomes are homologs of each other, except those in PHL067M10 and PHL114L00.
  • the Gp22/23 ORFs in these two genomes form a separate group and share little nucleotide similarity to the other Gp22/23 ORFs despite being present at the same locus in the genome.
  • This ORF appears in all the phage genomes on the minus strand suggests that this region may be part of the right arm. This is consistent with previous reports of a plus-strand transcriptional terminator that separates Gp22/23 from the rest of the left arm in PA6, PAD20, and PAS50 [11].
  • the 15 sequenced phages were screened against a panel of 69 Propionibacterium strains, including 65 P. acnes strains, three P. humerusii strains, and one P. granulosum strain. Except for the P. acnes strains KPA171202 and ATCC11828, all of these Propionibacterium strains were isolated from the same cohort of subjects sampled for phages. The genomes of all 65 P. acnes strains and three P. humerusii strains were sequenced. A phylogenetic tree of the 65 P. acnes strains based on the SNPs in their core genomic regions was constructed ( Figure 33 , left dendrogram).
  • the bacterial collection included all major lineages of P. acnes found on the human skin, with multiple strains representing each type: IA-1, IA-2, IB-1, IB-2, IB-3 and II.
  • the susceptibility/resistance of each of the 69 bacterial strains against each of our 15 sequenced phages was determined using a crossstreak method. In total, 1,035 bacterium-phage interactions were determined. Each experiment was repeated at least five times.
  • EOP efficiency of plaquing
  • Type IB-3 strains encode components of a type III restriction modification system (genes PPA1611 and PPA1612 in KPA171202). This may explain their resistance to phages.
  • KPA171202 encodes a cryptic prophage in the genome [17].
  • sequence of the prophage is not related to any of the sequenced P. acnes phages, therefore, the presence of the cryptic prophage is unlikely to explain the resistance to phages.
  • Three type II strains were also highly resistant to some of the phages. This is consistent with previous observations that strains of this type were more frequently resistant to phages [14].
  • P. granulosum is a common skin commensal with approximately 1.1% abundance in the pilosebaceous unit [7].
  • P. humerusii is a newly-defined species [18].
  • P. humerusii is one of the major species found on the skin with an abundance of 1.9% in the pilosebaceous unit [7]. It is closely related to P. acnes with >98% identity in the 16S rRNA gene sequence [18]. While the P.
  • P. humerusii strains showed strong resistance to all the phages tested, two P. humerusii strains, HL037PA2 and HL037PA3, were susceptible to all the phages.
  • the third P. humerusii strain, HL044PA1 was lysed by ten of the 15 phages tested. This suggests that the host range of P. acnes phages is not limited to P. acnes but also includes P. humerusii and possibly other closely-related Propionibacterium species.
  • RT2 and RT6 (RecA type II) and encode CRISPR/Cas genes, which function as a bacterial adaptive immune mechanism against foreign DNA.
  • These RT2 and RT6 strains each have one to nine spacers, 33 nucleotides long, in their CRISPR arrays. In total, they encode 42 spacers, 28 of which are unique.
  • the short nucleotide motif downstream of the protospacer known as the protospacer-adjacent motif (PAM)
  • PAM protospacer-adjacent motif
  • Mutations in these nucleotides have been found to disrupt CRISPR-mediated resistance despite complete complementarity in the protospacer sequence [20-22].
  • the PAMs of the nine protospacers that have exact matches to the spacer sequences encoded in HL042PA3 were examined.
  • acnes strains does not correlate with the presence of CRISPR spacers that match to phage protospacers, suggesting that additional mechanisms, such as regulation of the CRISPR/Cas system and/or other antiviral mechanisms, are needed in conferring the phage resistance.
  • P. acnes, P. humerusii, and P.granulosum strains were cultured under anaerobic conditions in Clostridial media (Oxoid) at 37°C for 4-6 days.
  • Propionibacterium cultures were used to prepare top agar overlays for phage culture on A media plates (12 g/L pancreatic digest of casein, 12 g/L Difco yeast extract, 22.2 mM D-glucose, 29.4 mM g/L potassium phosphate monobasic, 8 mM magnesium sulphate heptahydrate, 20 g/L Difco agar).
  • Plaques found on skin sample culture plates were isolated by puncturing the agar with a pipet tip and resuspending in 50 ⁇ L SM buffer (0.1 M sodium chloride, 8 mM magnesium sulfate heptahydrate, 1M Tris-HCl, pH 7.5, 2% gelatin, 1 mM calcium chloride).
  • the phage resuspension was spread onto A media plates with top agar containing P. acnes strain ATCC 6919. After incubation at 37° C for 2 days, phages were eluted with 8 mL SM buffer at room temperature, filtered with 0.22uM PES filter (Millipore), and stored at 4° C. Phage titers were determined by plaque assay.
  • Phage DNA extraction was performed using the Lambda Mini Kit (Qiagen) with the following modifications. Phage particles were precipitated in Buffer L2 by centrifugation at 20,000 g for 1 hour. Extracted DNA was eluted with Buffer QF and precipitated with isopropanol overnight at -20° C before centrifugation.
  • Phage genomes were sequenced in multiplex using the Roche GS FLX Titanium or Illumina MiSeq platforms. De novo assembly of reads was performed with MIRA [24], and the resulting contigs were manually finished in Consed [25]. For phages covered by more than 20,000 reads, assembly was performed on a randomly-selected subset of 10,000 reads for 454 data or 20,000 reads for MiSeq data. Fully assembled phage genomes were annotated using Genemark.hmm [26] and Glimmer v3.02 [27].
  • Sequences present in all 16 phage genomes were defined as core regions of the phage genome. To identify these core regions, alignments were first generated between the PA6 genome and each of the other 15 phage genomes using Nucmer [28]. This yielded 15 sets of starting and ending coordinates describing intervals within the PA6 genome that align with any given phage genome. The core regions were then calculated for all phages by determining the overlapping intervals between all of the 15 coordinate sets. The core region sequences were concatenated for the subsequent multiple sequence alignments. Single nucleotide polymorphisms (SNPs) on the core regions were identified by using the "show-snps" option of Nucmer with the default setting. Using MEGA5 [29], phylogenetic trees were constructed by the Neighbor Joining method on p-distances based on SNP sites. Bootstrapping was based on 200 replicates.
  • SNPs Single nucleotide polymorphisms
  • the susceptibilities/resistances of Propionibacterium strains against 15 phages were determined using a modified cross-streak assay.
  • the bacterial strains were cultured and streaked in parallel across A media plates (5-6 isolates on each plate, ⁇ 1 cm apart, along with ATCC 6919 as a control). Approximately 5 ⁇ L of 106 pfu/mL phage suspension was applied onto each streak, and then the plates were incubated at 37° C anaerobically for 2 days. At least five replicates of each cross-streak experiment were performed to determine whether the strains were susceptible or resistant judged based on lysis.
  • CRISPR spacer sequences were identified in P. acnes genomes using CRISPRfinder [35]. The extracted spacer sequences were aligned against all phage sequences using BLASTn. Protospacers with up to two mismatches were identified.
  • the genomes of 15 P. acnes phages isolated from human skin were sequenced.
  • the phage genomes showed moderately high sequence similarity and were comparable in size and organization. Based on a comparison of the genomes, most phages diverge from each other, while some of them form closely-related groups that were not described previously.
  • these phages When tested against a panel of 69 Propionibacterium strains, these phages lysed all P. acnes strains except some strains from type IB-3 and II. Some of the phages were also able to lyse Propionibacterium humerusii strains.
  • SEQ ID NOs 55-81 include four unique genomic sequences for strains in the IB-3 lineage and for several other strains, such as IB-3-s1 (IB-3 and SK187), IB-3-s2 (IB-3 and HL025PA1), IB-3-s3 (IB-3 and HL201PA1), IB-3-s4 (IB-3 and HL201PA1). The sequence similarities range from 95% to 100%. Primers targeting these sequences can be used to estimate and predict the effectiveness of phage therapy.
  • Figure 26 shows the phylogenetic tree of the 32 phages including the 18 sequenced phages.
  • phage strains highly similar to each other, such as the ones in Groups I and II. This suggests that the same phages can be found in different individuals and supports that a particular phage strain can be used as a common treatment agent for different individuals.
  • SEQ ID NOs 33-50 reflect the genome sequences of the 18 sequenced phages, including the 15 phages shown in Table 5.
  • Potential therapeutic phage for patients with microbiome type I include:
  • PHL113M01 PHL111M01, PHL082M00, PHL060L00, PHL067M10, PHL071N05, PHL112N00, PHL037M02, PHL085N00, PHL115M02, PHL085M01, PHL114L00, PHL073M02, PHL010M04, and PHL066M04.
  • Potential therapeutic phage for patients with microbiome type I with IB-3 strain include :
  • Potential therapeutic phage for patients with microbiome type II include:
  • PHL113M01 PHL060L00, PHL112N00, and PHL085M01.
  • Potential therapeutic phage for patients with microbiome type III or dominant RT8 include :
  • PHL113M01 PHL111M01, PHL082M00, PHL060L00, PHL067M10, PHL071N05, PHL112N00, PHL037M02, PHL085N00, PHL115M02, PHL085M01, PHL114L00, PHL073M02, PHL010M04, and PHL066M04.
  • Potential therapeutic phage for patients with microbiome type IV include :
  • PHL113M01 PHL111M01, PHL082M00, PHL060L00, PHL067M10, PHL071N05, PHL112N00, PHL037M02, PHL085N00, PHL115M02, PHL085M01, PHL114L00, PHL073M02, PHL010M04, and PHL066M04.
  • Potential therapeutic phage for patients with microbiome type V include :
  • PHL113M01 PHL111M01, PHL082M00, PHL060L00, PHL067M10, PHL071N05, PHL112N00, PHL037M02, PHL085N00, PHL115M02, PHL085M01, PHL1 14L00, PHL073M02, PHL010M04, and PHL066M04.
  • P. acnes phage strains can lyse a closely related Propionibacterium species, P. humerusii , which has been hypothesized to be associated with infection in prostheses.
  • P. acnes phage strains that can lyse P. humerusi i strains can be potentially used as a therapeutic agent for P . humerusii associated diseases.
  • Potential therapeutic phage for P. humerusii associated diseases include :
  • PHL113M01 PHL111M01, PHL082M00, PHL067M10, PHL071N05, PHL085N00, PHL085M01, PHL114L00, PHL073M02, and PHL010M04.
  • the patient has microbiome types IV or V, or is dominated by P. acnes RT10 strains, it is less likely antibiotic treament would succeed, because these strains are antibiotic resistant.
  • These patients should be treated using other therapies, such as retinoids or the methods.
  • the patient has the virulent ribotypes, including RT4, RT5, and RT8, drugs targeting specifically to RT4, RT5, and RT8, can be used.
  • small molecules, antisense molecules, siRNA, biologics, antibodies, or combinations thereof targeting the genetic elements and biological pathways unique to the P. acnes strains associated with acne, detailed above, can be used.
  • additional treatment of phage therapy based on the foregoing can be used.
  • bacteriophage-based strain-specific therapy to treat acne can be employed.
  • An alternative treatment strategy is to balance the relative abundance of the P. acnes strains by promoting the growth of health-associated strains.
  • the strains associated with health can be used as probiotics. These can be topical creams, solutions, or other cosmetic products.
  • vaccine can be developed against virulent strains of P. acnes.

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